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COPYRIGHT DEPOSIT. 






Copyright, 1913, by 
THB EMBALMING BOOK COMPANY 



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©CU34 6154 



DEDICATED 

TO 

THE MEMORY OF 

J. H. CLARKE, Dkan 

AND 

FOUNDER OF 

THE CINCINNATI COLLEGE OF EMBALMING 



PREFACE 



In writing this book the authors have taken cognizance 
of the necessity for a good working knowledge of Hygiene 
and Sanitation among embalmers. The position of the 
embalmer as a sanitarian is such as to provide him with 
great opportunities for the use of sanitation. These op- 
portunities are just as great, if not greater, than those 
coming to the man in the medical profession, in the fact 
that no one is closer to the contagion and infection in and 
around the dead body, than is the practical embalmer, and 
those who are attending the funeral of the deceased. 
Later discoveries in the transmission of disease warrant 
saying that actual contact infection is becoming more 
and more recognized as a most active mode of dissemina- 
tion. As against actual contact infection from a dead 
body, the embalmer, by a working knowledge of the 
nature, causation, modes of dissemination, and prophy- 
laxis against disease, is in a position to actively combat 
the spread of disease in a decisive manner. In water- 
borne infections, the embalmer should assert himself in 
the absence of a regularly constituted health officer, and 
see that all fecal matter and other such discharges are 
rendered innocuous to the living. The knowledge of the 
subjects listed in Parts One, Two and Three of this book 
will place in the embalmer 's hands effective and recog- 

v 



j PREFACE 

nized sanitary measures which he is to use when acting 
as a sanitarian, when such an officer does not exist, or to 
aid such a health officer in carrying out those sanitary 
principles in a community in which we are all so vitally 
interested. The inability of any organization to control 
the spread of disease throughout the rural districts in 
the same effective manner as could be done in larger 
organized communities is widely recognized. Air-borne 
infection, characterizing the dissemination of contagious 
diseases, is under a less decisive control than other classes. 
It is not so much the spread of a disease all over a rural 
district that we have reference to, as much as the spread 
of the disease to occupants of the same building in 
thickly populated tenement districts of our larger cities. 
It is entirely within the province of the embalmer to 
act as a fumigator or active sanitarian, and that, too, 
without encroaching upon the rights of any other recog- 
nized legal health officer, for general health and hygiene 
is everyone's business. This is not true of the embalmer 
who knows but little of the teachings and principles of 
sanitation, but is true of the person who has studied the 
principles as set forth in the teachings of this book or 
any recognized book, or who has been a student in a 
theoretical and practical manner under the supervision 
of qualified instructors. 

Prophylaxis in general, covers the methods in use to 
check the spread of the disease, as well as the protec- 
tion to those who are compelled, in the interests of their 
professional calling to be in close proximity to the body, 
as would be necessary where a body is to be embalmed. 
The authors remember at least a dozen instances where 



PREFACE vii 

careless and uninterested work in sanitation has resulted 
in the death of the embalmer, and one case in particu- 
lar where twenty-two people died in an epidemic the 
result of careless work in sanitation on the part of the 
acting embalmer. Embalmers, through improvement in 
their sanitary knowledge, are allowed to preserve and 
disinfect bodies, and in that way allow of their trans- 
portation and return home to the last resting-place. The 
various state laws governing embalming make it neces- 
sary that disinfection of the body be complete, under the 
penalty of a revoking of license for careless work. It be- 
hooves the student to be more careful and painstaking in 
his work at all times. 

It is for all of these reasons that we have spent many 
years in formulating the matter contained in this book. 
We have called on many authorities for information, 
among whom are Rosenau, Abbott, Renouard, Clarke, 
Meyers, Barnes, and those authors who have from time 
to time contributed articles to the current embalmers' 
journals. "We are deeply indebted to these men for infor- 
mation which we hope will prove as beneficial to those 
who study from this text-book as it has been to ourselves. 

Thoroughness has been our watchword in the prepara- 
tion of these pages for the student's education, and thor- 
oughness should be the watchword of the student in 
absorbing the theory and obtaining the practice in sani- 
tation, so that our fullest duty to the dead body and to 
those left behind may be realized, and our position in 
the rank of professions elevated to the highest pinnacle. 

THE AUTHORS. 



TABLE OF CONTENTS 



PART I. 
The Predisposing Causes to Disease. 

Chapter I. 

Predisposing Causes to Disease: PAGE 

Predisposing Causes 7 

Age 8 

Sex 9 

Race 10 

Occupation 11 

Density of Population 12 

Heredity 12 

Season 12 

Hunger and Thirst 13 

Heat and Cold 13 

Chapter II. 

Exciting Causes of Disease: 

Chemical , 14 

Physical 15 

Mechanical 15 

Chapiter III 

Exciting causes, — Continued : 

Vital 17 

Animal Parasites 18 

Vegetable Parasites 19 

Bacteriology 19 

Discovery of Bacteria 19 

Origin of Bacteriology 21 

Scope of Bacteriology 22 

Bacteria in the air 23 

Bacteria in the Soil 24 

Biologic Significance 25 

ix 



X TABLE OF CONTENTS 

PAGE 

Bacteria 26 

Morphology 26 

Bacterial Requirements 27 

Spores 28 

Cocci 29 

Bacilli 32 

Spirilla 33 

Bacteria, Divided as to Products They Live On 34 

Bacteria, Divided as to Oxygen Supply . 35 

Bacteria, Divided as to Products They Produce 35 

Yeasts 40 

Moulds . 42 

PART II. 

The Causation, Modes of Dissemination and 

Spread of Special Diseases. 

CHAPTER IV. 
Disease Description: 

Disease 47 

Discovery of Cause of Disease 51 

How Germs Enter Body 52 

Their Distribution in Body B 53 

Lesions Produced 54 

Toxins and Antitoxins Produced 54 

Elimination of Bacteria from Body 55 

Life History of Bacteria Outside Body 55 

CHAPTER V. 

Correct Names for the Causes of Death': 

General Diseases 57 

Diseases of Nervous System and of the Organs of 

Special Sense 58 

Diseases of the Circulatory System. 58 

Diseases of the Respiratory System 59 

Diseases of the Digestive System 59 

Non- Venereal Diseases 59 

Puerperal State 60 

Diseases of Skin and Cellular Tissue 60 

Diseases of Bones 60 

Malformations 61 

Diseases of Earlv Infancy 61 

Old Age " 61 

Affections Produced by External Cause3 61 

111 Defined Diseases 62 



TABLE OF CONTENTS x [ 

CHAPTER VI. 

Non-Contagious Diseases : page 

Anthrax 63 

Cerebro-Spinal Meningitis 66 

Erysipelas 66 

Glanders 68 

Gonorrhea 69 

Hydrophobia 70 

Relapsing Fever 71 

Syphilis 71 

Tetanus 72 

Actinomycosis 75 

Dengue 75 

Dysentery 76 

Malaria 77 

Yellow Fever 78 

CHAPTER VII. 

Slightly Contagious Diseases: 

Diphtheria . 80 

Tuberculosis 84 

Typhoid Fever 87 

Leprosy 94 

Pneumonia 94 

Influenza 95 

Cholera 96 

Plague 101 

CHAPTER VIII. 

Very Contagious Diseases : 

Scarlet Fever 104 

Smallpox 105 

Measles 108 

Mumps 109 

Whooping-cough 110 

Typhus Fever HI 

PART III. 
Prophylaxis in General Against Disease. 

CHAPTER IX. 
Vital Processes: 

Immunity 115 

Natural Immunity HG 

Acquired Immunity 117 



xii TABLE OF CONTENTS 

CHAPTER X. 

Special Processes: page 

Disinfection 119 

CHAPTER XI. 

Special Processes, Continued: 

Physical Disinfection 124 

Light 125 

Natural Electricity 127 

Natural Dessication 127 

Atmospheric Pressure 128 

CHAPTER XII. 

Special Processes, Continued: 

Mechanical Disinfection 129 

Electric Currents 129 

Electric Light 130 

Filtration 130 

Ozone 131 

CHAPTER XIII. 

Special Processes, Continued: 

Thermal Disinfection 133 

Flames, or Burning 134 

Dry Heat 134 

Boiling Water . . ., 137 

Steam 139 

Steam Under Pressure 140 

Fahrenheit and Centigrade Scales 141 

CHAPTER XIV. 

Special Processes, Continued: 

Chemical Disinfection 143 

Classification of Chemicals 146 

CHAPTER XV. 

Special Processes, Continued : 

Gaseous Disinfectants 150 

Formaldehyde Gas 151 

Sulphurous Acid Gas 165 

Chlorine Gas 168 

Oxygen 169 

Ozone 170 

Hydrocyanic Acid 170 



TABLE OF CONTENTS xiii 

CHAPTER XVI. 

PAGE 

Special Processes, Continued: 

Liquid Disinfection 172 

Formalin 172 

Bichloride of Mercury 175 

Carbolic Acid 177 

Cresols 179 

Lime 181 

Carbol-Sulphuric Acid 184 

Labarraque's Solution 184 

CHAPTER XVII. 

Special Processes, Continued: 

Solid Disinfectants 185 

Magnesium Sulphate 185 

Granulated Zinc Chloride 186 

Lime s 186 

CHAPTER XVIII. 
Antiseptics : 

Antiseptics 188 

CHAPTER XIX. 
Blood Solvents: 

Blood Solvents 191 

CHAPTER XX. 
Bleachers : 

Bleachers 193 

CHAPTER XXI. 
Insecticides : 

Insecticides 196 

Arsenic 199 

Bisulphide of Carbon 201 

Hydrocyanic Acid 202 

Petroleum 203 

Pyrethrum 204 

Sulphur i 205 

Formaldehyde Gas 207 

Destruction of Rats 208 

Insecticides, Use Around a Dead Body 210 

CHAPTER XXII. 
Deodorants : 

Deodorants 211 

Formalin 212 

Chlorinated Lime 212 



x « v TABLE OF CONTENTS 

PAGE 

Copper and Iron Sulphate 212 

Potassium Permanganate 213 

Piatt's Chlorides 213 

Dry Earth 214 

Charcoal , 214 

Ashes 214 

CHAPTER XXIII. 
Embalming" Fluids: 

Embalming Fluid 215 

Bad Results with Fluids 216 

Ideal Condition of Body 218 

Problem of the Circulation 218 

Dry, Medium and Moist Tissues 219 

Amount of Fluids to Inject 220 

Disinfection by Embalming Processes 221 

Fluid Formulae 222 

Mineral Poisons in Fluids : 223 

General Analysis of Fluids 224 

CHAPTER XXIV. 
Room Disinfection: 

Room Disinfection 234 

Sick Room and Its Disinfection 234 

Room Fumigation 238 

General Suggestions 244 

Charges 246 

CHAPTER XXV. 

Articles Requiring Special Attention: 

List of Articles 247-268 

Disinfection of One's Own Person 268 

Care of Body After Death 269 

Transportation of Dead Bodies . 270 



LIST OF ILLUSTRATIONS 



1. The first pictorial representation of bacteria. Leeu- 

wenhoek, 1863 . (Loeffler) 20 

2. Forms of cocci 31 

3. Forms of bacilli 32 

4. Forms of spirilla 33 

5. Yeast cells (Sedgwick and Wilson) 41 

6. Common moulds with their spores (Williams, after 

Banmgarten) 43 

7. Hot air sterilizer (McFarlanoVs Pathogenic Bacteria) 135 

8. Formalin lamp (Rosenau) . . 155 

9. Autoclave for evolving formaldehyde under pressure. 

(Rosenau) 159 

10. The Sheet Method (Embalmers Monthly) 162 

11. Bucket used in the formalin-permanganate method 

(Embalmers Monthly) 164 

12. The pot method of burning sulphur (Rosenau) ...... 166 

13. A disinfecting suit 237 

14. Method showing how to seal doors with paper strips 

(Rosenau) 239 

xv 



INTRODUCTION 



Although everyone will admit the importance of hy- 
giene and sanitary science, yet it seems often to be 
neglected. "Vigorous health and its accompanying high 
spirits are larger elements of happiness than any other 
thing whatsoever," and one way in which we can secure 
this happiness is by living up to the rules as set forth 
in the teachings of sanitary science and hygiene. It has 
been said that "health is a man's birthright; that it is as 
natural to be well as to be born," and it is from ignorance 
and transgressions of the sanitary laws that arise all dis- 
ease and tendency to disease. In view of the great im- 
portance of hygiene and sanitation, let us as undertakers 
and embalmers do all that is in our power to help in the 
prevention of disease. 

The Relation of the Undertaker to the Public 
Health. — The physician must do all he can for his pa- 
tient — saving his life, and, if possible, restoring him to 
health. In addition to this, to protect others, if possible, 
from the disease. The undertaker's obligation to the 
dead ceases with the respect and consideration due their 
bodies, and in the restoration and maintenance of as 
nearly a natural appearance as possible. To the public 
his obligation is great in preventing, if possible, infec- 
tion of the living, directly or indirectly from the dead. 

xvii 



xv iii INTRODUCTION 

The doctor's duty is to the living individual and to the 
public, and with death his responsibility ceases. The 
undertaker's duty is to the dead and the public, and with 
the death his responsibility begins. The respect and con- 
sideration due the dead is a matter of sentiment and ethics 
and is entirely subordinate to the welfare and the inter- 
ests of the living. The management and disposition of 
the dead is not a business, but a profession, and that, too, 
of scientific principles and practical art. Adequate quali- 
fications are necessary. The regulation of the undertak- 
er's profession by law is due the dead, the undertakers 
themselves, and the living. It seems important that the 
undertaker should have a knowledge of the following ■ 

(1) That the dead may communicate disease to him- 
self and to others. 

(2) That most of the acute diseases are infectious, de- 
pending upon living organisms, vegetable or animal, 
parasitic or saprophytic. 

(3) The way and maimer in which these organisms 
enter the living body. 

(4) Their distribution in the body, whether local or 
general and whether the solids or fluids, or both, are 
infected. 

(5) The way and manner of their elimination from the 
the body. 

(6) The way and manner in which they are trans- 
ferred to others. 

(7) That with the death of the host the bacteria do 
not concurrently die. 

(8) The way and maimer in which bacteria may be 
eliminated from the dead. 



INTRODUCTION xi x 

(9) The modes by which such eliminated bacteria may 
be transferred to the living. 

These should be a part of the scientific instruction of 
the undertaker. 

The Purposes of an Undertaker. — (1) To prevent and 
destroy putrefaction and restore the body to as nearly a 
natural appearance as possible. (2) To destroy all patho- 
genic bacteria, to prevent communication to the living, 
and contamination of the soil from the grave. 

In the body, dead of an infectious disease, there are 
present living pathogenic bacteria whose activities have 
ceased and living saprophytic organisms whose activi- 
ties begin. If the body is let alone, under favorable 
conditions, temperature, moisture, etc., the saprophytes 
will continue until the putrefactive portions of the body, 
soft parts and fluids, have been reduced to their normal 
elements, not dust, and in this general decomposing pro- 
cess- the living pathogenic bacteria are destroyed. 

Decomposition, therefore, is nature's way of destroy- 
ing pathogenic bacteria and decomposing the body com- 
pounds to their normal elements. Both of these are con- 
servative processes. During the process, however, there 
is danger of dissemination of pathogenic bacteria and 
possibly the generation of saprogenic poisons which may 
be dangerous if they find their way into the living body. 
From the sanitary standpoint, the destruction of the 
pathogenic bacteria is by far of the greatest importance. 

The method by which this may be accomplished is 
disinfection. (See Chapter X). Infected sputum, urine, 
feces, discharges, etc., from the living are best dealt with 
by burning. The same is true of all infected materials, 



xx INTRODUCTION 

cloths, bedding, etc. This form of disinfection is not 
always practical, as the destruction of property is expen- 
sive. Other forms of disinfection, though, can be used 
to great advantage. As to the cremation of dead human 
bodies, as a means of disinfection, public sentiment does 
not approve at this time, therefore a regulation to that 
effect would be ignored, although it is thought by some 
that the evolution of sentiment will lead to the adoption 
of cremation for the disposal of the dead. Disinfection 
consists in the employment of some chemical which will 
enter the protoplasm of the bacteria and destroy or poison 
them. Fortunately this applies to both pathogenic bac- 
teria and the saprophytes of putrefaction. The process 
by which this is accomplished is called embalming. This 
is applicable to the dead only. The great problem in 
curative medicine has been t^ find a chemical that will 
seek out the pathogenic bacteria in the living body and 
destroy them, and not hurt the living normal cells. The 
undertaker, of course, does not consider the cells of the 
body, so far as their protoplasm, function or life is con- 
cerned. Relation, symmetry, color, etc., from the view- 
point of appearance is all that concerns him, so far as 
the body itself is concerned. The antiseptics used in 
embalming, which in quantity and strength would be 
fatal to living cells, is to dead cells preservative by de- 
stroying putrefactive saprophytes that would destroy the 
cells and tissues of the body. To successfully embalm a 
body, the embalming fluid must come in contact with the 
tissues and fluids of the body to prevent putrefaction, 
and with all tissues and fluids that may contain patho- 
genic bacteria. If this is accomplished, then the objects 



INTRODUCTION Xxi 

of embalming are attained, viz. : the prevention of putre- 
faction and the death of pathogenic bacteria. It produces 
a sterile body, safe from decomposition and safe so far 
as communication of disease is concerned. Anything 
short of that implies a corresponding percentage of fail- 
ure. It must be remembered that embalming may be 
sufficient to preserve the body for a time and to prevent 
immediate communication of disease, but may not suffice 
to prevent contamination of the soil. With the proper 
treatment, embalming may be said to prevent contam- 
ination. 



PART I. 



THE PREDISPOSING CAUSES TO DISEASE. 



XX111 



Hygiene and Sanitary Science 



CHAPTER I. 

THE PEEDISPOSING CAUSES TO DISEASE. 

Hygiene is a science that deals with the laws of health 
in the broadest sense. Personal hygiene is that branch 
of the science which deals with man himself and how he 
is to keep healthy. 

Practical hygiene or sanitary science is the art of 
preserving health, or, of preventing disease, and includes 
a consideration of the methods that are employed in 
investigating the manifold phases of the subject. 

Sanitary bacteriology deals more particularly with 
the channels by which bacteria leave the body and pass 
into the outer w^orld ; with the mode and duration of life, 
of disease germs, in water, food, soil and air, and with 
the avenues by which these disease germs are able again 
to approach and infect the healthy individual. 

For the undertaker and embalmer, we do not care 
so much about personal hygiene, or man himself, as we 
do about practical hygiene or man's surroundings. "We 
want to determine in how far these conditions which the 
embalmer meets daily are conducive or detrimental to 
man's well-being, and to bring about the greatest amount 

1 



2 THE PREDISPOSING CAUSES TO DISEASE 

of disinfection possible, not only in the house in which 
man died, but by thorough and sanitary embalming, the 
complete disinfection of the body itself after death. By 
a complete knowledge and a strict adherence to these 
laws the undertaker and embalmer will, when acting 
as a sanitarian, maintain a healthy and sanitary condition 
in the house and community in which death has occurred 
from a contagious or highly infectious disease. 

Sanitary science is no new thing. From the earliest 
to the present time we have had ecclesiastical and medi- 
cal writings for the sanitary guidance of man. It is 
largely due to the inculcation of these precepts, handed 
down from generation to generation, that we follow cer- 
tain customs to-day and instinctively avoid certain condi- 
tions then thought to be harmful. 

The laws of Moses, although religious laws, were 
practically sanitary laws for the guidance of his people. 
As long as they obeyed these laws they were a healthy 
people, but when broken, disease reaked in their camp 
and sometimes whole tribes died. 

The public bath-house instituted in the Alexandrian 
period shows that the earlier civilizations held the ques- 
tion of public health as of vital importance. 

The Egyptians embalmed their dead. Perhaps this 
was a religious custom, but we do know that it was a 
sanitary measure, for the processes which they employed 
were sufficiently perfect to secure them an indefinite 
preservation. 

With the progress of time the earlier sanitary codes 
had to be recast to meet the requirements of newer condi- 
tions. The older regulations were based upon speculation 



THE PREDISPOSING CAUSES TO DISEASE 3 

and erroneous conceptions, but it must be admitted that 
they erred more frequently on the right side than on 
the wrong. 

The foundation of modern hygiene is laid in the sci- 
entific investigations of Von Pettenkofer, Voit, Koch and 
others. With the impulse given to the work by the intel- 
ligent deductions of these pioneers, there was a develop- 
ment, and to-day the field of hygiene and sanitary science 
has assumed such vast proportions that it has been divided 
up into specialties. 

The undertaker or the embalmer often must act as the 
sanitarian in small communities where they do not have 
a health officer. He must have the special knowledge 
necessary to thoroughly embalm the body, and to perform 
complete disinfection, or at least be able to advise the 
people of the community how it should be done. 

Why should the embalmer, trained to properly em- 
balm, equip himself with a knowledge that he is to employ 
in preventing death ? Why should the embalmer practice 
disinfection and sanitary science to keep the people from 
dying? These are questions that are sometimes asked. 
One might as readily ask, "Why does one experience the 
impulse to rescue a stranger from danger in whom he 
has no direct interest?" 

There is a moral reason why the embalmer should use 
his best endeavors to lessen suffering and save life, in so 
far as it lies in his power to do so, and this, too, regard- 
less of whether it is to be of direct profit to him or not. 
Secondly, there are material reasons for the embalmer 
to have a fairly accurate knowledge of the advances in 
preventive measures of sanitary science. His patrons 



4 THE PREDISPOSING CAUSES TO DISEASE 

demand it. With the universal progress in general edu- 
cation, the public is no longer satisfied that an embalmer 
enter the house, do his work in a haphazard way, and 
depart. They demand more. They wish to know the most 
likely channel or channels through which the disease may 
be contracted, and the most reliable means of preventing 
its recurrence or spread, if the body can be embalmed 
to make the public safe at the time of the funeral. If the 
embalmer can not supply reasonable answers to these 
questions, he need not be surprised if his employment is 
given to someone else who can. Thirdly, for his own 
enlightenment and personal welfare the embalmer should 
be familiar with the sanitary laws, especially those con- 
cerning the causation and spread of diseases and the 
means of prevention. He should be familiar with the 
channels through which he himself may become infected, 
or the means by w r hich he may serve as the carrier of 
disease germs, and the proper precautions for preventing 
such infection. As an educated embalmer he should know, 
and as a conscientious embalmer he should practice these 
precepts for the good not only of his own patrons, but of 
the community of which he forms a part. 

From time to time the teachings of hygiene are as- 
sailed by hostile attacks, and proof is demanded as to 
whether the practice of sanitary precepts has resulted 
in the betterment of the conditions under which mankind 
lives, in the prevention of disease, or in the saving of life. 
While it can not truthfully be said that every so-called 
sanitary precaution is beneficial or necessary, or that 
every article in the sanitary code is based on that which 
is proved to be sound, nevertheless we can combat ad- 



THE PREDISPOSING CAUSES TO DISEASE 5 

verse criticism with an array of evidence that would con- 
vince the most skeptical as to the importance of an in- 
telligent sanitary control of the conditions under which 
we live. For instance, to sight a few of the triumphs of 
hygiene, until the beginning of the present century the 
average percentage of deaths from smallpox in Prussia 
was 3 per 1,000 of population. Since the introduction of 
compulsory vaccination the mortality from this disease 
has fallen to its present figure of .03 per 1,000 of popu- 
lation. 

Typhus fever, so frequent in former times among the 
inmates of overcrowded hospitals and other public insti- 
tutions, has, under modern sanitary conditions, become 
a rarity. As a result of the proper drainage of the soil, 
a diminution in the frequency of pulmonary, intestinal 
and malarial troubles has everywhere been, observed. 

The triumphs in the art and science of sanitary em- 
balming are no less marked. The old ice-box has been 
superseded by the injection of the arterial system with 
the embalming fluid. The educated embalmer is assured 
that he can absolutely kill all germ life existing in or 
about the body, can render the body innocuous to the 
living, by the use of disinfecting solutions, and, too, can 
get the desired cosmetic effects. Dropsical cases are 
being taken care of in a sanitary way. Contrast, if you 
please, the time when these cases distended with water 
and inflated with gases were hauled to the cemetery, a 
stream of dropsical water running out of the back of the 
hearse. We have the complete disinfection of the body, 
so that it can be transported from one part of the the 
state to another, or from one continent to another, with 



6 'J'HE PREDISPOSING CAUSES TO DISEASE 

perfect safety and preservation. Our loved ones are no 
longer buried at sea, for our ocean steamers are carrying 
embalmers who, trained in their profession, are able with 
the modern light of sanitary science and embalming to 
so preserve the body that it can be taken to shore and 
then home, where it may have a burial as the family so 
desires. 

In citing these illustrations it is not our desire to 
leave the impression that our stock of knowledge is com- 
plete in all details, or that the knowledge we possess is 
utilized by every one to the extent that its importance 
demands. 

As has been stated, the object of hygiene is to prevent 
disease. It is therefore imperative that we have an un- 
derstanding of the means employed in securing this end, 
and that we possess a clear comprehension of the factors 
concerned in the causation and dissemination of disease. 

The causative factors in disease are manifold; they 
differ in nature the one from the other, and are of vary- 
ing degrees of importance in their relation to morbid 
conditions. Besides traumatisms and direct poisons, 
there is probably no single absolute cause of disease, but 
that the abnormal state we call disease represents a chain 
of circumstances, the various links of which, while having 
more or less direct bearing upon others, are of different 
degrees of importance to the progress. Thus we say that 
tuberculosis is caused by a specific organism, and no one 
doubts this but at the same time there is no one who 
believes for an instant that if to a number of individuals 
in sound health this microorganism gains access, tuber- 
culosis will certainly result in all cases. 



THE PREDISPOSING CAUSES TO DISEASE 7 

There are other factors that come into play and must 
be taken into consideration. On the one hand there are 
circumstances that modify disease-producing powers of 
the microorganism, so that at one time it may be com- 
paratively feeble as regards this property, while at an- 
other it is infective to the fullest extent. 

On the other hand, there are modifying influences 
constantly at work upon individuals, some of them plac- 
ing him in a condition to survive exposure to the most 
virulent forms of infection, while others so modify the 
normal vital resistance with which nature has provided 
him that he readily falls a prey to what would otherwise 
be a comparatively insignificant foe. 

Certain influences to which man is exposed during the 
course of his existence predispose him to disease in gen- 
eral. Other influences are concerned in directly exciting 
certain definite groups of symptoms. 

The Predisposing Causes of Disease. — By this term is 
meant those conditions with which man is surrounded 
that have a tendency to so reduce his normal vital powers 
so he is no longer capable of resisting the inroads of the 
direct exciting causes of disease. Agencies that tend to 
reduce the general health, such as exposure, fatigue, mal- 
nutrition, debauch, etc., tend likewise to diminish the 
vital resistance, and in this manner render the individual 
more susceptible to disease. "The ability of a micro- 
organism to produce disease in individuals of a particular 
race or species may be modified by a number of general 
factors that predispose individuals to infection or endow 
them with resistance. The conditions that determine 
whether a microbe can bring about infection or not are 
very various. ' ' — Jordan. 



8 THE PREDISPOSING CAUSES TO DISEASE 

Age. — The age of an individual is of great importance. 
Experiments have shown that while the adults of certain 
animal species are resistant to inoculation with particular 
germs, the young of the same species will succumb. The 
existence in the human race of a number of children's 
diseases, which are not only mora common but more fatal 
among children than among adults, is evidence to the 
same effect. 

Age can not be ignored. The greatest number of 
deaths, and hence the greatest amount of sickness, occurs 
among the very young and the very old, i.e., before the 
age of five and after the age of sixty-five to seventy 
years. 

In infancy and childhood we have : 

(1) Diseases connected with the development of ana- 
tomical structures and the establishment of physiological 
functions. 

(2) Diseases dependent upon the congenital defects. 

(3) Diseases due to special hereditary tendencies. 

(4) Diseases consequent upon the neglect of careless 
and inexperienced mothers. 

(5) Diseases resulting from undue exertion, as of oc- 
cupation, during and after pregnancy. 

(6) Diseases that occur in consequence of improper 
food and clothing, lack of cleanliness and pure air. 

(7) Diseases of a contagious character, occurring, 
such as measles, mumps, etc. 

In old age we have : 

(1) Diseases that depend upon the gradual loss of 
power on the part of the organs to perform their normal 
physiological functions, with the consequent disturbances 



THE PREDISPOSING CAUSES TO DISEASE 9 

of nutrition and the multiform abnormal manifestations 
that this defect entails. 

(2) Diseases degenerative in nature and which simply 
indicate irregularities that are incidental to the progres- 
sive wearing out of the machinery of life. 

(3) Diseases of the heart and arteries, renal and he- 
patic systems, catarrhal conditions of the mucous mem- 
branes, intemperance, rheumatic conditions, gouty affec- 
tions, cancers, tumors, etc. 

In adult life any disease may occur. During this 
period man's freedom from or affliction with diease will 
depend very largely upon the conditions under which he 
lives. 

The undertaker and the embalmer is able then to 
determine by the age of the subject the class of disease 
to expect. For example, he would not find a hardened 
condition of the arteries in a child, but would be very 
liable to get this condition in the adult over the age of 
thirty. He would not as a rule find contagious diseases 
such as measles or scarlet fever, etc., in adult life, but 
would be very liable to find these diseases in the child. 

The age of the subject will also determine the amount 
and character of the fluid to be used. In the child the 
undertaker will use less fluid and of less astringent char- 
acter, whereas in the adult more fluid will be used and the 
astringency will be greater. 

Sex. — The sex of an individual is a predisposing factor 
because of the particular anatomical structure. 

Males afford a greater number of deaths than females 
from the following: 



10 THE PREDISPOSING CAUSES TO DISEASE 

Typhoid, 

Venereal diseases, 

Alcoholism, 

Lead and other forms of poisoning, 

Tetanus, • 

Convulsions, 

Diseases of the brain and cord, 

Diseases of the liver, 

Renal diseases, 

Bladder and genito-urinary diseases, 

Bone diseases, 

Accidents. 

Females succumb more frequently than males to 

Malaria, 

Cancer, 

Anemia, 

Diseases of the stomach, 

Diseases of the reproductive organs, 

Peritonitis, 

Diseases incidental to pregnancy and child-birth. 

The undertaker and embalmer would not ordinarily 
expect to find a case dead of alcoholism in the female, 
but he might expect to find such a case in the male. We 
all know that a case of alcoholism is hard to treat, so 
our fluid would have to be modified to meet this condi- 
tion. He would not find a case of puerperal septicemia 
in the male, but might expect such a case in the female 
at any time. Here again the fluid would have to be modi- 
fied to meet the condition in hand. 

Race. — Some races exhibit a peculiar susceptibility 
to certain maladies, while others possess a comparative 



THE PREDISPOSING CAUSES TO DISEASE H 

degree of immunity from them. The negro is less sus- 
ceptible to yellow fever and malaria than the white man. 
The white man is less susceptible to pulmonary troubles 
and cholera than the black man. The German is more 
susceptible to cancer than the Celt. The Jew escapes 
more frequently from disease of a tuberculous nature and 
from epidemic diseases than does any other race of man- 
kind. An explanation of this vital advantage on the side 
of the Jews is stated by Richardson as follows: "The 
causes are simply summed up in the term ' soberness of 
life.' The Jew drinks less than the Christian, he takes 
as a rule better food, he marries earlier, he rears the chil- 
dren he has brought into the world with greater personal 
care, he tends to the aged more thoughtfully, he takes 
better care of his poor, he takes better care of himself." 

It is probable that there is no disease to which man- 
kind is liable, from which any race of mankind possesses 
absolute natural immunity. 

Occupation. — Certain kinds of occupations predispose 
to disease. However, with most occupations, disease is 
not due to the character of the work done, for moderate 
work of almost any kind, when done under favorable con- 
ditions, must be considered as in every way advantageous 
to the physical, moral and mental wellbeing of the worker. 

The conditions of occupation that most frequently 
predispose to disease and ill-health are generally poor 
hygienic surroundings, such as overcrowding in poorly 
ventilated, improperly heated, damp, and uncleanly 
offices and workshops ; the inhalation of dust-laden at- 
mosphere ; exposure to extremes of weather, as heat, 
cold, and excessive moisture ; the evil effects of working 



12 THE PREDISPOSING CAUSES TO DISEASE 

in cramped or strained attitudes, particularly such as 
interfere with the normal action of the heart and lungs. 

Density of Population. — Sickness and death are most 
frequent in those communities where large numbers of 
people are crowded together in comparative close quar- 
ters under the conditions of poverty. 

Heredity. — By heredity we mean the influence of par- 
ents upon offspring. Heredity is the peculiar tendency ex- 
isting in some families to nervous diseases, to epilepsy and 
insanity ; in other families the peculiar tendency to scrof- 
ulous, tubercular, rheumatic and gouty affections. Some 
families have a marked predisposition to acute diseases, 
while in others there is a marked resistance to them. 

The inheritance of a tendency to or an immunity from 
disease is due fundamentally to the same process through 
which peculiarities of the physical, moral or mental na- 
ture are transmitted. 

The question concerning the direct transmission of 
disease from parents to offspring is often disputed, but 
there can be no dispute about the hereditary tendency 
to a disease. Children born of parents having weak lungs 
and a general enfeebled constitution, will have a predis- 
position to pulmonary affections. 

Season. — Certain groups of diseases are most preva- 
lent at certain seasons of the year. During the months 
of low temperature we have catarrhal diseases and dis- 
eases of the respiratory system. Typhoid fever is a dis- 
ease of the early autumn, the greatest death rate occur- 
ring during the months of August, September and Oc- 
tober. 



THE PREDISPOSING CAUSES TO DISEASE 13 

Hunger and Thirst. — Hunger and thirst predispose to 
infection. If pigeons are kept on a low diet before or just 
after inoculation with anthrax bacilli, they die, although 
under normal conditions these birds are naturally im- 
mune to anthrax. Animals deprived of water also lose 
their natural resistance to anthrax inoculation. 

An unsuitable diet, as the substitute of bread and milk 
for meat, has the same effect. 

Heat and Cold. — Exposure to extremes of heat and 
cold is well known to depress resistance to infection. 
This is shown by one of Pasteur's classic experiments, in 
which he rendered the naturally resistant hen susceptible 
to anthrax by chilling it with cold water. 

The prevalence of pneumonia in man in those months 
of the year when the influence of cold upon the human 
being is most felt, affords another illustration of the 
same iact. 

Frogs, which are immune to anthrax at ordinary room 
temperature, quickly die after anthrax inoculation if 
placed at a temperature of 25 to 35 degrees Centigrade. 

Hot and moist climates are seats of disease. Dry 
climates, either cold or hot, are comparatively healthy. 



CHAPTER II. 

THE EXCITING CAUSES. 

The Exciting Causes of Disease. — The term direct or 
exciting, as applied to the cause of disease, is limited 
to those chemical, physical and mechanical agencies that 
are capable of inducing abnormal conditions in the organ- 
ism without the intervention of any other modifying 
factors. 

The vital agents too, we believe, are capable at any 
time of performing their characteristic pathologic func- 
tion, provided the body is in a peculiarly receptive con- 
dition. This receptive condition usually depends upon 
some influence already mentioned as predisposing. 

The exciting causes of disease after birth must, of 
necessity, be of external origin. It is evident that these 
causes of acquired disease are either of the nature of 
alterations in the environment which tell directly upon 
one or another tissue, or are due to the entrance into the 
system from without of substances, either living or dead, 
which have a deleterious action upon the functions of 
the tissues. " Thus briefly we may classify the agents 
producing disease acquired after birth into: (1) Chem- 
ical. (2) Physical (3) Mechanical. (4) Vital 

Chemical. — The direct chemical causes of disease are 
divided into those having their origin outside of the body 
and those that are created inside the body, 
14 



THE EXCITING CAUSES 15 

Ectogenous. — Are those that have their origin outside 
the body. They comprise the numerous organic and inor- 
ganic substances of irritating or poisonous nature, that 
possess the property of causing abnormal local or consti- 
tutional diseases. 

The most common of these are (1) the various hurtful 
substances used in certain trades, as for example : 
phosphorus, arsenic, mercury, acids, etc. (2) Those used as 
drugs, such as opium, chloral, cocaine, alcohol, etc. (3) 
The poisons of some plants, such as Rhus Toxicodendron, 
Atropa Belladonna, Hyoscyamus niger, Eicinus Crotin Tig- 
Jium, etc. (4) The poisons of venomous reptiles. 

Endogenous. — Are those that have their origin inside 
the body. They are created as the result of mal-nutrition, 
mal-formation, and other defects of metabolism and phy- 
siological functions. 

A poison is a non-organized substance, organic or in- 
organic, existing within the organism or introduced from 
without, which, from its chemical composition, is able 
under certain conditions to be harmful to human beings, 
by destroying or effecting their health or relative well- 
being. 

Physical. — The most frequent direct physical causes 
of disease and death are excessive heat, cold and moisture. 
Physical agents, such as heat and cold, can either cause 
the suffocation or freezing of a person so as to excite 
disease or death. 

Mechanical. — Under mechanical causes of disease we 
would have all those conditions in which structural or 
physiological diseases are brought about by mechanical 



16 THE EXCITING CAUSES 

means, such as accidental causes, etc. Under this form no 
disease of germ origin would be classed, but simply those 
diseases which are brought about by accident, etc. 

Statistics have been formulated giving the number 
of persons affected by accidental causes of disease. In 
the number of persons affected the list is as follows : 

Every year, 11,000,000 

day, 30,137 

hour, 1,255 

" minute, 19 

Of the above numbers the following number die and 
are treated by the undertaker: 

Every year, 57,000 

day, 156 

hour, 7 

9 minutes, 1 

Out of each 100 deaths from all causes there are 
deaths from accident to the number of 6, making a per- 
centage of 6. 

The undertaker, then, should make a special study 
of the treatment of accidental causes of death in order 
that he may be able to cope with any situation. As a 
rule the only concern from a bacteriological standpoint 
is the gas bacteria which may infect the blood of the 
body, thereby giving rise to capillary and tissue gas. 



CHAPTER III. 

THE EXCITING CAUSES.— Continued 

Vital Causes. — By the term vital causes of disease is 
meant those living germs which, having gained access to 
the body, produce as a result of their development under 
favorable conditions, tissue lesions that terminate in 
the disturbance of important vital functions and fre- 
quently in local or complete death of the host in which 
they are developing. 

Germs are the lowest forms of vegetable or animal 
life, and include the terms microbe, bacterium, ovum, 
spore, an undeveloped embryo, etc. 

A microbe is a microorganism, or an organism so 
small that the microscope must be used to make it visible. 

A bacterium, a genus of fission-fungi, meaning the 
lowest form of plant life, deriving its substance from dead 
organic matter and dividing by direct division. 

An ovum is the female reproductive cell of an animal 
or a vegetable. 

A spore is any reproductive element less organized 
than a true cell. A spore is a highly resistant organism 
produced by a bacteria, yeast, or mould, that will again, 
when it comes under favorable conditions (as the seed 
will the plant), reproduce itself and produce like kind 
from which it came. 

An undeveloped embryo is the first cell in human 

17 



18 THE EXCITING CAUSES— CONTINUED 

life, which if fertilized and developed would result in a 
foetus. 

A germ cell is a cell resulting from a fecundal germ- 
inal vesicle. 

A germ disease is any disease of microbic origin. 

Germ force is plastic or constructive force. It is that 
force which is stored up in the seed, and, when planted in 
the proper soil, with the required temperature and moist- 
ure, will cause it to grow. 

Germ plasm is germinal protoplasm transmitting in- 
herited peculiarities. 

The germ theory, (1) the theory that all infectious 
diseases have a germ origin. (2) The doctrine that every 
living organism has its origin, from a germ. 

Germs are divided into vegetable parasites and animal 
parasites. 

Animal Parasites. — The lowest group of the animal 
kingdom is known as the protozoa. The protozoa are dis- 
tinguished from the higher animals by the fact that each 
organism consists of but a single cell. The disturbances 
that result from the invasion of the body by animal para- 
sites or protozoa vary with the character, mode of nutri- 
tion, life cycle, and location of the invading organism. 
In the one case they may manifest themselves through 
symptoms that point more particularly to the circulating 
blood; in the other, by more or less grave disturbances 
of nutrition. Again, nervous irritability will be observed. 
In special instances marked and persistent diarrhea re- 
sults, while in other instances the results of their pres- 
ence in the body produce mechanical irritation. 

A great many protozoa are pathogenic to man as well 



THE EXCITING CAUSES— CONTINUED 19 

as to animals. Dysentery is due to an animal parasite. 
Malarial fever is also due to animal parasites, which are 
carried into the body by the bite of certain kinds of 
mosquitoes. 

Vegetable Parasites. — Vegetable parasites are divided 
into bacteria, yeasts and moulds. 

Bacteriology. — The role which bacteria play in the 
production of disease is quite important. Bacteriology 
is the science which treats of bacteria and the lowest 
forms of microorganisms in vegetable and animal life. 

Discovery of Bacteria. — The belief that there are liv- 
ing organisms too small to be seen by the unaided eye, 
and that such invisible organisms play an important part 
in the various natural phenomena, has found utterance 
many times since the dawn of history. Several of the 
philosophers of antiquity were bold enough to surmise 
that such organisms existed, and some, writers even 
framed their speculations on this subject in phrases that 
seem like far-seeing anticipations of modern discoveries. 

Interesting in some degree as these speculations are, 
they appear to have had no influence whatever upon the 
course of scientific investigation, and to have been let 
fall at random by their authors, like hundreds of similar 
conjectures, without any real basis in observation or 
experiment. 

The fact is, that prior to the work of the Dutch micro- 
scopist, Anthony van Leeuwenhoek, in the latter part of 
the seventeenth century, definite ocular proof for such 
a belief did not exist. Leeuwenhoek (1632-1723), who 
was a skilled lense maker of Delft, Holland, spent many 



20 THE EXCITING CAUSES— CONTINUED 

years in examining through his microscope a great variety 
of natural objects, with unremitting industry if without 
system, and in the course of his observations chanced to 
come across the organisms now known as bacteria. In a 
letter to the Eoyal Society of London, dated Sept. 14, 
1683, he records in these words his observations upon 
some tartar scraped from the teeth and mixed with 
water : "I saw with wonder that my material contained 
many tiny animals, which moved about in a most amusing 



•^^^ 




Fig. 1. - The first pictorial representation of bacteria. 
Leeuwenhoek, 16£3 (Loeffler). 

manner; the largest of these (a) showed the liveliest and 
most active motion, moving through the water or saliva 
as a fish of prey darts through the sea ; they were found 
everywhere although not in large numbers. A second 
was similar to that marked (b). These sometimes spun 
around in a circle like a top, and sometimes described 
a path like that shown in figure (c-d). They were also 
present in large numbers. A third kind could not be 
distinguished so clearly; now they appear oblong, now 
quite round. They were so small that they did not seem 
larger than the bodies marked (e), and besides they 
moved so rapidly that they were continually running into 



THE EXCITING CAUSES— CONTINUED 21 

one another; they looked like a swarm of gnats or flies 
dancing together. I had the impression that I was look- 
ing at several thousand in a given part of water or saliva, 
mixed with a particle of material from the teeth not larger 
than a grain of sand, even only when one part of the 
material was added to nine parts of water or saliva. Fur- 
ther the greater part of the material consisted of an 
extraordinary number of rods, of widely different lengths, 
some curved, some straight, as (f). Since I had pre- 
viously seen animalcules of this same kind in water, I 
endeavored to observe whether there was life in them, 
but in none did I see the smallest movement that might 
be taken as a sign of life." Leeuwenhoek supplemented 
his observations with drawings, and there is no doubt 
that he was the first to see bacteria and to describe them 
accurately. 

Origin of Bacteriology. — Leeuwenhoek 's observations 
remained practically isolated and without fruit for nearly 
a century. In 1786 the Danish zoologist, 0. F. Muller, 
took up the work and succeeded in discovering many 
structural details of which his predecessors had been 
ignorant. Ehrenberg (1795-1876) succeeded in giving 
a somewhat complete classification. Then follow Du jar- 
din, Perty, Colin, and Nageli. 

Pasteur (1822-1895) showed that bacteria and kindred 
microorganisms were responsible for setting in motion 
and carrying out many every day processes, the nature 
of which had not been understood, or which had been 
incorrectly assigned to the "Oxygen of the Air/' or to 
other inorganic agencies. 

Putrefaction and decay were shown by Pasteur to 



22 THE EXCITING CAUSES— CONTINUED 

be not fields for "spontaneous generation'' of life, but 
manifestations of chemical disintegration due to the meta- 
bolic activities of microorganisms engaged in satisfying 
their need for food. 

Fermentation was shown to be caused by the effort 
of living and growing yeast cells to satisfy their nutri- 
tional requirements. 

Pasteur is looked upon as the founder of the science 
of bacteriology. Eobert Koch must be regarded as estab- 
lishing bacteriology on the basis of an independent 
science. 

The postulates of Koch are as follows: 

(1) That the microorganisms under consideration 
shall always be found in the diseased tissue, and in such 
relation to these tissues that they can be reasonably 
assigned an etiological relation to the process. 

(2) That the microorganism shall be isolated from 
the diseased tissue in pure cultures. 

(3) That the pure cultures of the microorganisms 
shall be capable when inoculated into susceptible animals, 
of reproducing pathological lesions identical with those 
from which they w^ere originally isolated. 

(4) That the microorganism shall be found in the 
lesions produced by the inoculation. 

Scope of Bacteriology. — Although from a practical 
point of view, the part played by bacteria in the causa- 
tion of disease in man must be admitted to be of surpass- 
ing importance, it must not be forgotten that bacteria 
exert a marked influence upon the welfare of mankind 
in many other directions. 

Bacteria not only disintegrate and destroy dead bodies 



THE EXCITING CAUSES— CONTINUED 23 

and attack and kill living organisms, but some forms 
are also constructive to a high degree, and translate im- 
portant chemical elements, like nitrogen and carbon, from 
unavailable combinations into substances that can be 
utilized by higher forms of plant life. 

It has been discovered, for example, that certain kinds 
of bacteria profoundly modify the composition of the 
soil and the character of the crops, and are hence of im- 
portance to the agriculturalist; that other kinds of bac- 
teria impart the characteristic flavors and aromas to but- 
ter, cheese and other dairy products ; and that still others 
determine the success or failure of various industrial 
processes, such as retting of flax, the tanning of hides 
and the curing of tobacco. It is believed by many that 
the applications t>f bacteriology to various industries and 
manufactures and to agriculture are likely to become 
much more numerous in the near future. 

Bacteria in the Air. — As might be supposed, the num- 
ber of bacteria in the air bears a close relation to the 
quantity of suspended dust particles. There are fewer 
bacteria in the air of the country than of the city; there 
are fewer in the mountain air than in the air of the low- 
lands ; the air in mid-ocean and in high altitudes is gener- 
ally germ free. 

Pasteur, in an experiment made during the course 
of his celebrated researches on spontaneous generation, 
observed that only twelve of the flasks out of twenty 
of organic infusion, which were opened at a low altitude, 
escaped infection, while out of twenty opened on the 
Mer de Glace, nineteen escaped. 

Tyndall's experiment at the Bel Alp, in Switzerland. 



24 THE EXCITING CAUSES— CONTINUED 

was a yet more emphatic instance of the same kind. 
Ninety per cent, of the flasks opened in a hay loft were 
smitten, while not one of those opened on the free moun- 
tain ledge was attacked. 

The kinds of microorganisms in the air vary some- 
what in different localities, but certain forms are pretty 
uniformly present. Moulds and yeasts are quite common 
in the atmosphere and in some situations outnumber the 
bacteria. 

Bacteria in the Soil. — The distribution of the bacteria 
in the soil is naturally dependent upon the presence of 
organic matter, moisture and other factors that influence 
the development and continued vitality. More bacteria 
are found, for example, in manured soil than in dry sand. 
The upper six inches of the soil are the richest in bacteria. 
Few bacteria are found in the undisturbed soil below a 
depth of four or five feet. 

The supply of bacteria in the soil is continually being 
renewed by the excrements of animals, by the bacteria 
concerned in the various fermentative and putrefactive 
processes occurring everywhere, and by those that are 
precipitated from the air by the rain. 

Spores of the anthrax bacillus may retain their vi- 
tality and virulence in the earth for many years and 
pasture lands that are once infected with anthrax, be- 
come practically unsafe for grazing cattle. Typhoid 
bacilli sometimes find their way into the soil along with 
human excretia. For this reason, feces should always be 
disinfected. 

The burial of bodies of persons dying from infectious 
diseases does not as has been sometimes surmised tend 



s THE EXCITING CAUSES— CONTINUED 25 

to perpetuate pathogenic germs. Bather elaborate experi- 
ments by Losimer and others have shown that the longev- 
ity of non-spore bearing bacteria under the ordinary 
conditions of earth burial is not long, a few weeks suffic- 
ing for the complete disappearance of the cholera spiril- 
lum, and the bacillus diphtherae, etc. 

The arguments against earth burial therefore, do not 
seem to be decisive; whatever the force of esthetic and 
economic objection may be, the soil seems to go through 
a process of self -purification. 

Biologic Significance. — The fact should not be over- 
looked that bacteriology owes its present important place 
among the biologic sciences quite as much to its general 
scientific significance as to the success of its practical 
applications. It has been often pointed out that the 
change in man's conception of the world around him that 
has been produced by bacteriology is so sweeping as al- 
most to deserve the term revolutionary. Up to the mid- 
dle of the nineteenth century the character of many of 
the most familiar of natural processes, such as decay, 
fermentation, and the like was entirely misunderstood; 
contemporary spontaneous generation of at least the 
lower forms of life was the general accepted belief of 
most scientific men; infectious diseases were not sharply 
differentiated from one another and the most fantastic 
hypotheses were advanced to explain their existence. 

Although the great mass of material phenomena else- 
where had been brought into apparent orderliness and 
system, yet here was a region in which the unscientiiie 
imagination rioted in mystery and extravagance. The 
penetration of this realm of obscurity by the discovery 



26 THE EXCITING CAUSES— CONTINUED 

of bacteria, gave the human race for the first time in 
history a rational theory of disease, dispelled the myths 
of spontaneous generation and set the. processes of decay 
and kindred phenomena in their true relation to the great 
cycle of living and non-living matter. The new concep- 
tion of the microscopic underworld which bacteriology 
brought into biologic science must be reckoned as a con- 
spicuous landmark, and in so far as it has changed the 
attitude of man toward the universe, should be regarded 
as the most important triumph of natural science. 

Bacteria. — For the human being and many of the 
lower animals, the most important of the vegetable para- 
sites that are directly concerned in the production of 
disease are the bacteria. Bacteria are the smallest and 
simplest forms of plant life known, consisting of a 
single cell and devoid of chlorophyll. Or another defini- 
tion would be that bacteria are unicellular vegetable 
microorganisms that multiply by transverse division. 

Morphology. — Individual cells differ in size, shape, 
method of cell division, spore formation and the like. 
Masses of cells when grouped together are called colonies. 
The average bacterium of rod shape measures about two 
microns in length, and 0.5 microns in diameter. (One 
micron is equal in length to 1-25,000 of an inch). One 
large spherical bacterium that has been described meas- 
ures about two microns in diameter. 

Bacteria divide by transverse division. That is, if 
the bacteria are in the proper temperature, moisture, and 
media, in one hour we would have two, in two hours we 
would have four, in three hours we would have eight, in 



THE EXCITING CAUSES— CONTINUED 21 

four hours it would be sixteen, etc., etc., until in three 
day's time 4,720,000,000,000 would be produced. No or- 
ganism, however, as was pointed out by Darwin long ago, 
can increase in exact geometric progression, for various 
checks and hindrances are always placed upon its multi- 
plication by natural causes. In the case of bacteria, a 
potent factor that tends to prevent unlimited multiplica- 
tion is found in the interference with growth caused by 
the substance produced by bacteria themselves. All other 
factors, such as insufficient food, lack of moisture, un- 
suitable temperature, and the competition of other kinds 
of bacteria, play a part. 

A capsule sometimes surrounds bacteria, and in 
stained preparations is seen as a halo. 

A cell membrane encloses the bacteria, which differs 
from the cell membranes of plants in that it contains 
no cellulose. 

The bacterium has no true nucleus, but the nuclear ma- 
terial is generally conceded to be distributed about irreg- 
ularly in the cell substance. 

Flagella, are long, fragile, filamentous appendages, 
which originate from the outermost layer of the cell, and 
convey the power of locomotion to the bacteria. 

Bacteria are greatly effected by temperature, light, 
moisture, oxygen supply, and food supply. 

The Bacterial Requirements. — The requirements are the 
proper temperature, moisture, and media. 

By the proper temperature we mean that each and 
every class of bacteria has an optimum temperature, 
at which growth takes place best. This can be modified 
to some extent by gradually increasing or diminishing 



2g THE EXCITING CAUSES— CONTINUED 

the temperature. Thus a bacterium that normally grows 
at 37 degrees Centigrade, or body temperature, can by 
proper methods, be made to grow at a much lower tem- 
perature. Each bacterium has a maximum temperature at 
which it will grow, and if taken above or below these 
temperatures will either produce the spore form or die. 

The same can be said in regard to moisture. Moisture, 
although absolutely necessary, can be diminished, but if 
diminished too far, the bacteria will dry up and die, or 
else change into the spore form. 

In regard to media, each bacterial colony grows best 
on the cultural media it has been used to growing on. 
If this media is taken away, the bacteria will die or else 
change into the spore form. And it may be said that jjist 
as a fish needs water for life, so do the bacteria need 
the proper temperature, moisture, and media, for life. 

Spores. — A spore is a highly resistant body produced 
by a bacterium, yeast or mould, that will again when it 
comes under favorable conditions reproduce itself (as the 
seed does the plant) and bring forth like kind from which 
it came. Fig. 3 and 6. 

The bacteria which produce spores are called spore 
bearing bacteria. The spore bearing variety are by far 
the most hearty and resistant to the effects of destructive 
disinfectant agents. The non-spore bearing variety, as a 
rule, possess very light powers of resistance to destructive 
agents, and are killed quickly. 

True spores resist a temperature of from 70 to 100 
degrees Centigrade, and are characterized by definite 
structural qualities. They are approximately spherical 
or oval in shape. Spores are highly resistant to all sorts 



THE EXCITING CAUSES— CONTINUED 29 

of injurious influences. When the spore begins to form, 
the nuclear material is concentrated into a hard mass. 
A spore may be formed in any part of a cell, sometimes 
in the center and sometimes at the end. As a rule, a 
single cell forms only one spore. Spore formation among 
bacteria, therefore, is not a reproductive device for mul- 
tiplying the number of individuals of a species, but signi- 
fies a resistant stage, for the purpose of meeting the ad- 
vent of unfavorable conditions of life. The spore is to 
be considered as a resting stage. It serves to tide the 
species over a period of dryness, famine, or unsuitable 
temperature, and to preserve alive in hostile environment 
a suitable number of individuals until such a time when 
favorable conditions recur. The spore stage is anaiagous 
to the periods of hibernation, or estivation among higher 
forms of life. 

After the spore has again regained its favorable con- 
ditions for growth, it will again germinate, and reproduce 
like kind from which it came. 

Fortunately, however, only a few of our pathogenic 
diseases, such as anthrax and tetanus, produce spores. 
This naturally facilitates and simplifies the disinfection 
and treatment of infectious diseases. 

Bacteria are divided according to shape into cocci, 
bacilli and spirilla. 

1. Cocci. — These are the rounded or the spherical 
form of bacteria. In this group the cells range from 
0.5 to 2 microns in diameter, but most measure about 1 
micron. (1 micron equals 1-25,000-inch). Before divi- 
sion, they may increase in size in all directions. The 
species are usually classified according to their mode of 
division. 



30 



THE EXCITING CAUSES— CONTINUED 



IIU • 




O 

o 
o 
o 



cU 



ft 

CQ 



U 
CD 

•4-> 
O 



a § 

& s 



u 

c3 

a. 
3 

& 

be 

CD 






2 

ft 



O 



THE EXCITING CAUSES— CONTINUED 31 

(a) Micrococci. — These appear singly and alone. 
There may be millions of them present in a small area, 
but each of them is independent of the others. The word 
micrococcus usually refers to all the classes of the cocci. 

(b) Streptococci. — If the cells divide only in one 
plane or axis, and through the consistency of their envel- 

o$?p& & ft 

oo W 

b 







oo 

Wgp *° (P (ft * 

c d 

Fig. 2. — Forms cf Cocci, a, micrococci and staphylococci; 6, streptococci; 
c, dipiococci; d> tetrads; e, sarcinae. 

opes remain attached, then a chain of cocci will be found. 
A species in which this occurs is known as streptococcus. 

(c) Staphylococci. — If division takes place irregu- 
larly, the resultant mass may be compared to a bunch of 
grapes, and the species is called staphylococcus. Fig, 2, a. 

(d) Tetrads. — Division may take place in two planes 
or axes at right angles to each other, in which case cocci 
adhere to each other in packets of four, called tetrads ; or 
sixteen may be found, the former number being the more 
frequent. 

(e) Dipiococci. — The individuals in a group of mi- 



32 THE EXCITING CAUSES— CONTINUED 

crococci often show a tendency to remain united in twos. 
These are spoken of as diplococci. Pig. 2, c. 

(f) Sarcinae. — Usually included in this group are 
coccus-like organisms which divide in three planes or 
axes at right angles to each other. These are usually 
referred to as sarcinae. They resemble a bale of cotton. 
If the cells are lying single they are round, but usually 
they are seen in cubes of eight, with the sides which are 
in contact, slightly flattened. Large numbers of such 
cubes may be lying together. The sarcinae are as a rule 
some larger than the other members of the group. Fig. 2, e. 

2. Bacilli. — These are the rod-shaped form of bacteria. 
They consist of long or short cylindrical cells with 






** v or 










-~/vK~ 






Fig. 3.— Forms of bacilli, c, diplobacilli; b, single bacilli; c-d. strepto- 
bacilli; e-f. spore forms. 

rounded or sharply rectangular ends, usually not more 
than one micron broad, but varying very greatly in 
length. 

They may be motile or non-motile. Where flagelia 



THE EXCITING CAUSES— CONTINUED 33 

occur they may be distributed all around the organism 
or only at one or both of the ends of the bacillus. 

A flagelluru is a whip-like projection like a tail ex- 
tending from the body of a bacterium, which will enable 
it to move by the lashing movement of the whip. 

Many species have spore forms. The spores may be 
located centrally, or terminally, and may be round, oval 
or spindle shaped. 

(a) Diplobacilli. — The individuals in a group may 
show a tendency to remain united in twos. These are 
spoken of as diplobacilli. 

(b) Streptobacilli. — Since bacilli always divide in 
one plane or axis by transverse division, and because of 
a peculiar arrangement of the capsule, they may remain 
attached. A chain of bacilli will thus be found. A species 
in which this occurs is known as streptobacillus. 

3. Spirilla. — Some of the elongated bacteria have a 
remarkable twisted form and bear some resemblance to 
a corkscrew. These are called spirilla. 




% v 



e d 



Fig. 4.— Forms of spirilla. 



(a) Spirochaeta. — A subdivision of spirilla, whose in- 
dividuals are not only twisted, but are also very flexible, is 
called spirochaeta. 

(b) Vibrio. — In this type the unit is a short curved 



34 THE EXCITING CAUSES— CONTINUED 

rod, often referred to as a " comma' ' or "horseshoe" 
shape. This type is known as vibrio. 

Bacteria, Divided as to the Products They Live On. — 

As regards the life process of bacteria, they lead either a 
saprophytic or a parasitic existence. 

In this regard, then, bacteria are divided as to the 
products they live on into either saprophytes or para- 
sites. Each of these classes is then divided into either 
obligative or facultative, as the following outline will 
show : 



Bacteria J 



1 



Parasites 



Saprophytes 



Obligative 
Facultative 

Obligative 
Facultative 



A saprophyte is one that grows on dead organic 
matter ; that is, it develops without a living host. 

A parasite is one that depends for its existence upon 
the conditions offered by either a living animal or plant, 
in or on which it develops. 

Both saprophytes and parasites have their obligative 
and facultative forms. In this sense the term obligate 
as applied to a saprophyte implies that it can live only 
on dead matter. 

When applied to a parasite, that it can develop only 
within a living host. 

The designation facultative, as applied to a parasite 
or a saprophyte, implies that these organisms possess the 
power of leading either a parasitic or a saprophytic form 
of existence, according to the circumstances. 



THE EXCITING CAUSES— CONTINUED 35 

Bacteria, Divided as to Oxygen Supply. — Bacteria may 
be divided into aerobic and non-aerobic (anaerobic) 
classes with reference to their need of oxygen. 



Bacteria 



Aerobic 



Non-aerobic 



Facultative 
Obligative 

Facultative 
Obligative 



The obligative aerobes are those that require free 
oxygen for the maintenance of their life activities. 

The obligative non-aerobes are those that do not 
grow except in the almost complete absence of free oxy- 
gen. 

The facultative aerobes or anaerobes are those that 
can thrive in either the presence or the absence of oxygen. 

Bacteria Divided as to the Products They Produce. — 
(a) Zymogenic bacteria. — These products ferment. Fer- 
mentation was not due, as Liebig for a time maintained, 
to the presence of dead and dying yeast cells which, in 
the course of their own molecular disintegration, toppled 
over and dragged down certain complex organic mole- 
cules with which they were in contact, but on the con- 
trary, was caused by the effort of living and growing 
yeast cells to satisfy their nutritional requirements. 

Some of the zymogenic germs are as follows : 

Bacillus acido lactis, bacillus lactis, micrococcus urea. 

(b) Saprogenic bacteria. — These produce putrefac- 
tion. Putrefaction and decay were shown by Pasteur to 
be not fields for the "spontaneous generation" of life, 
but manifestations of chemical disintegration due to met- 



36 THE EXCITING CAUSES— CONTINUED 

abolic activities of microorganisms engaged in satisfy- 
ing their need for food. 

Saprophytes live inside the intestines of the human 
body in great numbers, surviving on the feces. Klein 
estimates that the feces excreted daily contain one-third 
their weight of saprophytes, giving us a bacterial count 
of between eighty-eight hundred billion and one hundred 
and twenty-eight trillion bacteria. 

Saprophytes are the most abundant of the bacteria. 
They are found on the surface of the body normally and 
in cases of gangrene. They pass out into the tissues 
after death, as experiments with the guinea pig show 
that within thirty minutes after death bacteria find their 
way to the outside of the organs, while at the end of 
sixteen hours they have thoroughly invaded all the tis- 
sues and set up a complete state of putrefaction at a 
temperature of 60 degrees Fahrenheit or over. 

Saprophytes are present everywhere, in the air, earth, 
water and food. Deep mines and high mountain tops 
have the smallest number, so as a rule we can never hope 
to escape them. They cover the skin, are in the orifices, 
some eighty different varieties having been found upon 
the hands and the feet, and under the nails. They also 
cover the entire alimentary canal from the mouth to 
the anus. 

Saprophytes are given the credit of doing all the dis- 
coloration and putrefactive work upon the dead body. 
But little is written about the parasites that also must 
take a most active part in the destruction and reduction 
of the human body to its normal elements. Some may 
claim that all bacteria found in the dead body are sapro- 



THE EXCITING CAUSES—CONTINUED 37 

phytic, while others may claim that the pathogenic class 
are not saprogenic, but it is a fact known to every under- 
taker and embalmer that a case of septicemia, pyaemia, 
puerperal septicemia, child-birth fever, all forms of blood 
poisoning, erysipelas, typhoid fever and the others, all 
containing bacteria in the blood, go to pieces rapidly 
soon after death, and can only be kept in condition by 
using large amounts of embalming fluid. One of two 
conditions must exist in these cases: either the infective 
pathogenic bacteria cause the rapid decomposition them- 
selves, or they have so prepared the tissues for the recep- 
tion of the saprophytes, thus causing an early decompo- 
sition. There is no doubt in the writer's mind but that 
this latter statement is true. 

Some of the saprogenic germs are as follows : 

Bacillus colli communis, Bacillus putrescens, 

Bacillus termo, Bacillus putridus, 

Bacillus cadaverens, Proteus vulgaris, 

Bacillus intercellularis, Bacillus subtillis. 

(c) Chromogenic bacteria. — These produce color. 

Some of this class are as follows: 

Bacillus citreus produces a yellow color. 

Bacillus violescens produces a violet color. 

Bacillus fluorescens produces a green color. 

Orange sarcine produces an orange color. 

After death there are usually discolorations which 
occur here and there over the body. These discolorations, 
which are the result of putrefactive changes, are caused 
by certain chromogenic bacteria which have the power 
to produce color. Thus over the abdomen there is a 



gg THE EXCITING CAUSES— CONTINUED 

greenish discoloration, which is caused by a certain class 
of putrefactive bacteria of a chromogenic nature, usually 
the bacillus fluorescein. 

(d) Aerogenic bacteria. — These produce gas. 
Examples of this class would be, any of the sapro- 
genic germs mentioned in a preceding paragraph. 

After a body dies, almost immediately aerogenic bac- 
teria and putrefactive bacteria enter the tissues of the 
body. As a result of their fast development and multi- 
plication under favorable conditions, putrefaction of the 
tissues ensues, and this is accompanied with a formation 
of gases which distends the different parts. 

The formation of gas in the stomach and intestines 
is known as abdominal gas, while the formation of gas in 
the tissues of the body is known as capillary tissue gas, 
which is most marked in the tissue just beneath the skin. 
It must be remembered, then, that these gases are caused 
by aerogenic bacteria, and should the embalmer want 
to arrest the formation of gas he must introduce a fluid 
that will be germicidal to them, and the fluid must of 
necessity reach all the parts affected. 

(e) Photogenic bacteria. — Many bacteria have the 
power to form light, giving to various objects which they 
inhabit a characteristic glow or phosphorescence. 

Bacteria of this class are as follows : Bacillus fluores- 
cens, bacillus phosphorescens. 

The undertaker and the embalmer have no particular 
interest in this class of bacteria, and they are only given 
here to have a complete classification. 

(f) Thermogenic bacteria. — This class of bacteria; 
produce heat. After a body dies it is subject to decom- 



THE EXCITING CAUSES— CONTINUED 39 

position and decay, unless retarded by some external 
procedure. At the time of death the temperature of the 
body is about 96.6 degrees, but as soon as death takes 
place the temperature of the body gradually sinks to 
that of tbie surrounding atmosphere. It has been noted 
that when putrefaction sets in now, that the temperature 
is increased a fraction of a degree, and this is attributed 
by scientists to the action of germ life, and it is to this 
class of bacteria that the name thermogenic is given. 
Other than this, the undertaker and the embalmer have 
no special interest in this class . 

(g) Toxicogenic bacteria. — This class of bacteria pro- 
duces poison. Some examples of this class are the bacillus 
prodigiosus, bacillus vulgaris, spirillum rubin. 

In fact almost any pathogenic bacterium, when it once 
gains entrance to the human body, produces as a result 
of its growth and development under favorable conditions 
certain poisons or toxins which are considered harmful 
to the human body, and this results in a particular dis- 
ease or toxemia. 

These toxicogenic bacteria abound everywhere, and it 
is for this reason that undertakers and embalmers should 
be careful while operating on a dead body so as not 
to cut themselves. But if this accident should occur 
the best thing to do is to squeeze out all the blood possible 
from the wound and then place the part in embalming 
fluid and wrap up the part with a clean bandage saturated 
with the formaldehyde fluid. Then later, should the 
wound show signs of any future trouble, a physician 
should be consulted at once. 

(h) Pathogenic bacteria.— These produce disease. 



40 



THE EXCITING CAUSES— CONTINUED 



Some of the pathogenic 

Bacillus diphtheriae, 
Bacillus influenzae, 
Bacillus Koplik, 
Bacillus anthracis, 
Bacillus pestis, 
Bacillus mallei, 
Bacillus lepra, 
Bacillus tetani, 
Bacillus typhosus, 
Bacillus tubercle, 
Tetrad of mumps, 
Spirillum of cholerae, 
Gonococcus, 
Etc. 



bacteria are as follows: 

causing diphtheria, 
influenza, 
whooping cough, 
anthrax, 
bubonic plague, 
glanders, 
leprosy, 
tetanus, 
typhoid fever, 
tuberculosis, 
mumps, 
cholera, 
gonorrhea. 



Pathogenic microorganisms, such as tubercle bacilli 
and the pyogenic cocci, have been found in the air of hos- 
pitals and sick-rooms, but as a rule pathogenic bacteria 
in the dry dust are of rare, rather than of frequent occur- 
rence. 

Yeasts. — Yeasts are fungi that are characterized es- 
pecially by a mode of division or multiplication, called 
budding. 

The cells are spheroid in shape or egg-shaped in form, 
and possess well-defined cell walls. They are much larger 
than the bacteria. All true yeasts form spores under 
suitable conditions. The usual number of spores is four, 
but some yeast like organisms have been found with eight 
spores. Yeast spores are quite common in the atmosphere 
and in some situations outnumber the bacteria. 



THE EXCITING CAUSES— CONTINUED 



41 



Yeasts have long been known for their ability to pro- 
duce alcoholic fermentation, and the technical study of 
these organisms has been chiefly carried on in connection 
with brewing and other practical operations. A variety 




Fig. 5.— Yeast cells (Sedgwick and Wilson). 

of familiar processes, such as the raising of dough, are 
effected through their agency. 

Pathogenic Yeasts. — The study of the pathogenic 
yeasts dates practically from the discovery by Busse in 
1894 of a generalized fatal infection apparently caused 
by a yeast. Certain skin diseases are caused by yeasts. 
A disease of the mouth, known as parasitic stomatitis or 
thrush, is caused by a yeast. 



42 THE EXCITING CAUSES— CONTINUED 

Moulds. — Mould is the white, cottony appearance 
which may be seen on damp bread, on jellies and pre- 
serves, etc. They are fungi which reproduce by end or 
threadlike growth, each thread or filament interwinds and 
interlaces with other filaments, producing the matted felt- 
like appearance. 

The spores of moulds are everywhere, and are usually 
more abundant than bacteria in ordinary air. Mould is 
the source of the so-called potato-rot, and grain infected 
with mould causes poisoning in man called ergotism. Most 
moulds are parasites for higher plants. 

A small number have pathogenic properties for the 
higher animals, including man. Certain abscesses found 
in the lungs, peritoneal cavity and brain, due to moulds, 
are fatal. The skin affection usually known as ringworm 
is also caused by a mould. This infection is communica- 
ble from man to man, and may also be contracted from 
the horse, cat, dog and other domestic animals. 

Moulds are also quite frequent and common in the 
atmosphere, and are frequently a source of trouble to 
the housekeeper from their tendency to attack fruit, 
preserves and similar substances. 

Bodies placed in receiving vaults and other temporary 
places are subject to the formation of mould on the face. 
As a preventive treatment, vaseline (petrolatum), is ap- 
plied to the skin. This can be removed again before the 
body is shown. 

As a curative treatment, grain alcohol and acetic 
ether are used on a piece of cloth, and the mould is re- 
moved by rubbing. This treatment also dries the skin and 



the Exciting causes— continued 



43 




Fig-. 6.— Common moulds with their spores (Wiliams, after Baumg-arten) . 



44 



THE EXCITING CAUSES— CONTINUED 



prevents a recurrence of the mould for some time. It is 
sometimes necessary to use a scalpel to scrape the mould. 
This should never be done, however, unless the solution 
is used first. 

Formula for the solution: 

-^ ( Grain alcohol ) _ 

Rx - \ Acetic ether \ Equal parts - 



PART II. 

THE CAUSATION, MODES OF DISSEMINATION 

AND 
SPEEAD OP SPECIAL DISEASES. 

45 



CHAPTER IV. 



DISEASE DESCRIPTION. 



Disease. — Disease is the opposite of "ease," or any 
abnormal condition of the body. 

Only one in every forty persons dies of old age. About 
twice that number meet death by accident, while disease 
is responsible for over nine-tenths of the mortality of the 
human race. 

The numerous diseases affecting man may be divided 
into two classes, known as infectious and non-infectious. 



Infectious 

or 
Communicable 



Contagious 
Non-contagious 



Disease <> 



Non-infectious 

or 
Non-communicable. 

Non-infectious diseases result from a disturbance of 
the functions of any one of the organs of the body 
through natural causes. 

Imperfect nutrition and imperfect circulation of the 
blood, as well as the presence of poisons formed within 

47 



48 DISEASE DESCRIPTION 

the body, will also cause diseases that can not be trans- 
mitted from one person to another. Headache, toothache, 
neuralgia, alcoholism, diabetes, insanity, cancer, etc., are 
examples of non-infectious diseases. 

Infectious diseases are caused by tiny plants or ani- 
mals, called parasites, feeding upon the human body, 
which is their host. These parasites, the smallest of which 
are commonly called microbes or germs, make one ill, 
chiefly by means of their poisonous excretions. In 
Europe and America 60,000,000 people are annually laid 
prostrate by infectious diseases, which result in over 
3,000,000 deaths. 

Infectious diseases result from the presence and re- 
production of pathogenic germs within the healthy body. 
Infection is the communication of disease from one per- 
son to another by direct or indirect contact or inocula- 
tion. Contagion is the process of transfer of specific 
diseases. Contagium is the name usually given to the 
morbific matter or virus which actually causes the dis- 
ease. It is the thing which is transferred. Inoculation 
is the introduction of specific virus into the system through 
an abrasion of the skin. 

As here employed, the term infectious refers espe- 
cially to the morbific agents causing disease, and im- 
plies nothing as to the mode of transmission of these 
agents. It is evident that the term infection, as relating 
to the causation of disease, is broader than the word con- 
tagious, which relates only to the manner of transmission. 
The term infectious disease is usually understood as dis- 
tinct from contagious; infectious diseases are dissemin- 
ated indirectly, i.e., in a roundabout way, by means of 



DISEASE DESCRIPTION 49 

food, water or soil, and enter the body by means of the 
digestive tract; also by inoculation by means of insects, 
such as flies, fleas, mosquitoes, etc. 

All communicable diseases are infectious, whether or 
not an infectious disease is contagious in the ordinary 
sense, depends upon the nature of the infectious agent, 
and especially upon the manner of its elimination from 
and reception by the body. 

Infectious diseases are divided into contagious and 
non-contagious diseases. A contagious disease is one 
transmissable from individual to individual by immediate 
or direct contact; the infectious agent is usually carried 
by means of the atmosphere, and enters the second body 
by means of the respiratory system. Such infectious ail- 
ments as consumption, smallpox and scarlet fever, which 
may be contracted by breathing the germs floating in the 
air, are called contagious because the healthy acquire 
the disease by coming near where the sick are or have 
been. All contagious diseases are also infectious and 
are dependent upon the activities of vital pathogenic 
agents in the tissues. 

Maladies like yellow fever, lockjaw and malaria be- 
long to the group of non contagious diseases, for the 
reason that persons living in the same house and even 
sleeping in the same bed with the sick do not become ill 
unless a mosquito or a sharp instrument conveys the 
germs from the sick to the well. 

The characteristics of communicable diseases, as to 
their manner of transmission, gives rise to another form 
of classification. 

Endemic diseases are those peculiar to a people or a 



50 DISEASE DESCRIPTION 

nation, occurring naturally in a certain district. Asiatic 
cholera, occurring naturally about the delta of the Ganges 
river in India, is an example. 

Sporadic diseases are those that are scattered, occur- 
ring here and there at irregular intervals. Cerebro- 
spinal meningitis, or any of the communicable diseases, 
could be classed as sporadic, providing they occur accord- 
ing to this definition. In this instance each of the cases 
is isolated from the other. 

Epidemic diseases are those that affect a large num- 
ber of people in a certain community and where it seems 
probable that the disease has been induced by the same 
source of infection. The typhoid epidemic would be an 
example of epidemic disease. 

A pandemic disease is one affecting two or more 
countries or nations at the same time. The prevalence of 
influenza in temperate latitudes would be an excellent 
example of a pandemic disease. 

The descriptive- terms applied to diseases are as fol- 
lows : 

An acute disease is one that runs a rapid, short and 
severe course. 

A chronic disease is one that runs a long, less rapid 
and less severe course. 

A specific disease is one where the cause and origin 
is known. 

A non-specific disease is one where the cause and 
origin is not known. 

A self -limited disease is one that limits itself, or 
where it is known how long it will "fake for the patient 
to get well. 



DISEASE DESCRIPTION 51 

Aii unlimited disease is one where we do not know 
how long it will take for the patient to get well. 

The Discovery of what causes Disease. — Several hun- 
dred years ago disease was thought to be due to evil 
spirits which took up their abode in the body. Here 
they produced continuous suffering until driven out by 
various devices such as beating the patient with a strap 
or giving him so-called medicine consisting of powdered 
human bones. Although for fifty years it had been 
thought by some that many diseases were due to bacteria, 
yet the fact that each of certain diseases is caused by a 
particular bacterium was not clearly proven until 1876. 
In that year Louis Pasteur, of France, showed that an- 
thrax, a sickness of cattle, was caused by a rod-like plant. 
He secured a few of these plants from the blood of a sick 
cow, and planted them in broth, where they increased 
rapidly in number. A few were then injected under the 
skin of a healthy cow, which soon afterward became 
sick. In her blood the same plants were found in vast 
numbers. Dozens of similar experiments and the pres- 
ence of these particular plants and no others in the blood 
of all animals with anthrax, have made it certain that 
the disease is caused by this specific germ. In a similar 
manner or by some other equally reliable method it has 
been shown that each of the following ailments is pro- 
duced by its own particular kind of germ: diphtheria, 
typhoid fever, malaria, pneumonia, leprosy, tetanus, 
hydrophobia, influenza, erysipelas and tuberculosis, etc. 

There are a number of diseases that are infectious. 
and therefore in all probability due to some microorgan- 
ism, but concerning the actual causation of which there 



52 DISEASE DESCRIPTION 

is at present either much difference of opinion among 
competent observers or absolute uncertainty. Those of 
this class are as follows: smallpox, hydrophobia, yellow 
fever, whooping cough, scarlet fever, measles, foot and 
mouth disease, Rocky Mountain spotted fever, mumps 
and infantile paralysis. 

Inasmuch as all infectious diseases may be prevented 
by keeping the germ out of the body, much effort has 
been made to study how they gain entrance. 

How Germs enter the Body. — The germs of any con- 
tagious disease may be taken in by breathing, but other 
channels of infection are also known. Influenza (or 
grippe), pneumonia, diphtheria, sore throat and whoop- 
ing cough are no doubt often contracted by a healthy 
person drinking from the same cup lately used by those 
just recovering from sickness. Numerous disease germs 
as well as harmless ones are present in the sputum of 
such patients. By examining with the microscope, a glass 
touched by the lips has been found to contain over 20,000 
bacteria. One single touch of the finger, moistened with 
saliva to aid in turning the pages of a book, might con- 
tain over 5,000 germs. The fingers touching the soiled 
books, clothing, pencils or instruments used about the 
sick-room or dead body, may convey the germs to the 
mouth. The number of days elapsing from the time the 
germs enter the body to the time when the disease appears, 
is known as the incubation period. Other disease germs 
might get into the body by direct inoculation, as for 
example in tetanus, where infection is brought into the 
body by stepping on a rusty nail ; or in yellow fever, 



DISEASE DESCRIPTION 53 

where the animal parasite is directly inoculated into the 
body with the bite of a mosquito. 

The manner of their introduction into the body is as 
follows : 

(a) Direct contact. Through contact of infected or- 
gans or parts with non-infected organs or parts. Through 
the instrumentality of infected materials — sponges, in- 
struments, cloths, books, etc. — which have been in contact 
with the infected persons and subsequently in contact 
with non-infected persons. 

(b) Through the inspired air. It is doubtful if or- 
ganisms enter free and unassociated with the inspired 
air into the body. It is undoubtedly true that organisms 
generally cling to or are in some material. Fine particles 
of any material — solid, semi-solid or fluid — may be the 
carrier of organisms into the body through the inspired 
air. The air itself, clear of these particles, is sterile, and 
is also sterile if these particles are sterile. 

(c) With food and drink. The most frequent sources 
of some diseases are water contamination, uncooked and 
improperly cooked food of all kinds, the infected flesh, 
blood, organs or products of infected animals, etc. 

(d) With infected materials through the urethra, va- 
gina or rectum. 

(e) With bites from intermediate hosts, such as flies, 
mosquitoes, rats, fleas and other animals. 

(f) With the male and female cells of generation. 
Their Distribution in the Body.— The infection may 

be local or general. A local infection is limited to the 
place of introduction. A general infection embraces more 
or less all the body or some particular system, and the 
blood. Auto-infection is a growth and spread of bacteria 



54 DISEASE DESCRIPTION 

in the body, and the manner is as follows : Continuity of 
tissues or organs; through the lymphatics; by the leuco- 
cytes or white blood cells; from one organ to another 
by the transportation of the infected material, e.g., swal- 
lowed sputum bringing about tuberculosis of the bowels; 
the urine from a tubercular kidney bringing about the 
same disease of the bladder. 

Lesions Produced. — There is a vast difference in the 
effects produced by different bacteria. A classification 
may be made as follows: 

(a) Those which produce little or no local lesions, 
as for example the tetanus bacillus. 

(b) Those which produce some characteristic inflam- 
matory product, such as the membranes produced in 
diphtheria. 

(c) Those which peptonize the tissue and form pus, 
as for example the pyogenic organisms; those which de- 
stroy in mass the tissue, forming sloughs, such as certain 
kinds of phlegmonous inflammations. 

(d) Those which create new tissue by cell prolifera- 
tion or growth, which subsequently degenerates, such as 
the tubercle. 

(e) Those which circulate in the blood, producing no 
lesion, such as the anthrax bacilli. 

Toxins and Anti-toxins Produced and their Effects. — 
All bacteria produce toxins, and some at least anti-toxins 
which either neutralize the toxins or destroy the bacteria. 
The self-limitation of most of the acute infectious dis- 
eases is explained in this way. For this reason anti-toxin 
is greatly used for the prevention of certain diseases, 
such as diphtheria, anthrax, tetanus, hydrophobia, etc. 
A toxin is a poison produced by bacteria. An anti- 



DISEASE DESCRIPTION 55 

toxin is a substance developed in a body and which has 
the power of counteracting a poison. 

The Manner of their Elimination or Discharge from 
the Body. — The manner in which bacteria may leave the 
body and pass into the outer world is one of trans- 
cendent importance in the prevention of disease. The fol- 
lowing is a summary of the methods by which bacteria 
may leave the body: 

(a) In the discharge from infected organs, as for ex- 
ample, the sputum, the feces, urine, pus, secretions, etc. 

(b) In droplets of condensed vapor of the breath. 

(c) Solid, semi-solid, or liquid particles from the skin. 

(d) On the skin appendages, hair and nails. 

(e) In the blood in hemorrhagic conditions. 

(f ) Through the instrumentality of insects which feed 
upon or come in contact with secretions, feces, urine, etc., 
or suck the blood from infected persons. 

The Life History of Bacteria outside of the Body. — 
If bacteria all died as soon as eliminated from the body, 
or if they were thereby rendered harmless, preventive 
medicines would be greatly simplified. Unfortunately, 
however, such is not the case. The most of the epidemics 
are caused by facultative bacteria, which contaminate the 
soil, water, and food, as for example, the bacteria causing 
typhoid fever, cholera, dysentery, etc. Some bacteria do 
not multiply outside of the living host, but may survive 
as individuals for considerable periods. Some not only 
survive, but are capable of multiplying indefinitely, there- 
by maintaining the species under purely saprophytic con- 
ditions. Some require an intermediate host for their per- 
petuation under ordinary conditions, such as the parasites 
causing malarial fever. 



CHAPTER V. 

THE CORRECT NAMES FOR THE CAUSES OF DEATH 

AS LISTED BY THE INTERNATIONAL 

LIST OF CAUSES OF DEATH. 

The undertaker for a long time has been desirous of 
getting the accurate names which should appear on the 
death certificates. 

Recently the different countries have gotten together 
in conference, and have formulated what is known as the 
International list of causes of death. All physicians now, 
in signing death certificates, are compelled by law to 
assign as the cause of death a name which is recognized 
by this International list. 

We have therefore appended this list so that the un- 
dertaker may have an exact list of the causes of death 
as they will occur on the death certificate when handed 
to him. 

Many of these names are scientific, some of which 
we have taken up and described as to treatment in "Ana- 
tomy and Embalming," Nunnamaker-Dhonau. Those 
which are not described can be found in Gould's Medical 
dictionary. 

Every practicing embalmer should own a dictionary 
of this kind for reference in case diseases are mentioned 
in the certificate or by the physician with which the 
56 



CORRECT NAMES FOR CAUSES OF DEATH 



57 



embalmer is not familiar. It is widely recognized that 
some knowledge of the nature and location of the disease 
should be had by the embalmer so that his treatments may 
be directed in the proper manner. 

The following is the list of the causes of death as they 
will appear on the death certificate and are taken from 
the International list of causes of death. 

I.— GENERAL DISEASES. 



1. 


Typhoid fever. 


25. 


2. 


Typhus fever. 




3. 


Relapsing fever. 


26. 


4. 


Malaria. 


27. 


5. 


Smallpox. 


28. 


6. 


Measles. 


29. 


7. 


Scarlet fever. 




8. 


Whooping cough. 


30. 


9. 


Diphtheria and croup. 


31. 


10. 


Influenza. 


32. 


11. 


Miliary fever, (Febris 






miliaris.) 


33. 


12. 


Asiatic cholera. 




13. 


Cholera nostras. 


34. 


14. 


Dysentery. 


35. 


15. 


Plague. 


16. 


Yellow fever. 


36. 
37. 


17. 


Leprosy. 


18. 


Erysipelas. 


38! 


19. 


Other epidemic diseases : 
Mumps, 


39. 




German measles, 


40. 




Chicken-pox, 






Rocky Mountain spotted 


41. 




(tick) fever, 






Glandular fever, etc. 




20. 


Purulent infection and 


42. 




septicaemia. 




21. 


Glanders. 


43. 


22. 


Anthrax. 


44. 


23. 


Rabies. 


45. 


24. 


Tetanus. 





Mycoses, Actinomycosis 
of lung. 

Pellagra. 

Beriberi. 

Tuberculosis of the lungs. 

Acute miliary tuberculo- 
sis. 

Tuberculous meningitis. 

Abdominal tuberculosis. 

Pott's disease, (tubercu- 
losis of spine.) 

White swellings, (tuber- 
culosis of — joint.) 

Tuberculosis of other or- 
gans. m 

Disseminated tuberculo- 
sis. 

Rickets. 

Syphilis. 

Gonococcus infection. 

Cancer of the buccal cav- 
ity. 

Cancer of the stomach, 
liver. 

Cancer of the perito- 
naeum, intestines, rec- 
tum. 

Cancer of the female gen- 
ital organs. 

Cancer of the breast. 

Cancer of the skin. 

Cancer of other or un- 
specified organs. 



58 



CORRECT NAMES FOR CAUSES OF DEATH 



46. Other tumors (tumors of 

the female genital or- 
gans excepted.) 

47. Acute articular rheuma- 

tism. 

48. Chronic rheumatism and 

gout. 

49. Scurvy. 

50. Diabetes. 

51. Exophthalmic goitre. 

52. Addison's disease. 

53. Leuchsemia. 

54. Anaemia, chlorosis. 



55. Other general diseases : 

Diabetes insipidus, 
Purpura hasmorrhagca, 

56. Alcoholism (acute or 

chronic). 

57. Chronic lead poisoning. 

58. Other chronic occupation 

poisonings : 
Phosphorus poisoning 

(match factory), 
Mercury poisoning 
(mirror factory), etc. 

59. Other chronic poisonings : 

Chronic morphinism, 
Chronic cocainism, etc. 



II.— DISEASES OF THE NERVOUS SYSTEM AND OF 
THE ORGANS OF SPECIAL SENSE. 



60. Encephalitis. 65. 

61. Meningitis : _ 66. 

Cerebro-spinal fever or 
Epidemic cerebro- 67. 

spinal meningitis. 
Simple meningitis. 68. 

6:?. Locomotor ataxia. 

63. Other diseases of the 69. 

spinal cord : 70. 

Acute anterior polio- 
myelitis, 71. 
Paralysis agitans, 72. 
Chronic spinal muscular 73. 

atrophy, 74. 

Primary lateral sclero- ■ 

sis of spinal cord, 75. 

Syringomyelia, etc. 

64. Cerebral haemorrhage, 76. 

apoplexy. 



Softening of the brain. 

Paralysis without speci- 
fied cause. 

General paralysis of the 

insane- 
Other forms of mental 
alienation. 

Epilepsy. 

Convulsions (non-puer- 
peral.) 

Convulsions of infants. 

Chorea. 

Neuralgia and neuritis. 

Other diseases of the ner- 
vous system. 

Diseases of the eyes and 
their annexa. 

Diseases of the ears. 



HI.— DISEASES OF THE CIRCULATORY SYSTEM. 



77. Pericarditis. (Acute or 

chronic; rheumatic.) 

78. Acute endocarditis. 

(Cause?) 

79. Organic diseases of the 

heart. 



Chronic valvular dis- 
ease. 
Aortic insufficiency, 
Chronic endocarditis, 
Fatty degeneration of 
heart, etc. 



CORRECT NAMES FOR CAUSES OF DEATH 



59 



80. Angina pectoris. 

81. Diseases of the arteries, 

atheroma, aneurysm, etc. 

82. Embolism and thrombo- 

sis. 



83. Diseases of the veins 

(varices, haemorrhoids, 
phlebitis, etc.) 

84. Diseases of the lymphat- 

ic system (lymphangitis, 
etc.) 

85. Haemorrhage. 



IV.— DISEASES OF THE RESPIRATORY SYSTEM. 



86. Diseases of the nasal fos- 03. 

sse. 94. 

87. Diseases of the larynx. 

88. Diseases of the thvroid 95. 

body. 96. 

89. Acute bronchitis. 97. 

90. Chronic bronchitis. 98. 

91. Broncho-pneumonia. 

92. Pneumonia. 



Pleurisy. 

Pulmonary congestion, 
pulmonary apoplexy. 

Gangrene of the lung. 

Asthma. 

Pulmonary emphysema. 

Other diseases of the res- 
piratory system. 



V.— DISEASES OF THE DIGESTIVE SYSTEM. 

Hernia o 

Other diseases of the in- 
testines. 

Acute yellow atrophy of 
the liver. 

Hydatid tumor of the 
liver. 

Cirrhosis of the liver. 

Biliary calculi. 

Other diseases of the 
liver. 

Diseases of the spleen. 

Simple peritonitis. 

Other diseases of the di- 
gestive system. 

VI.— NON-VENEREAL DISEASES OF THE 
GENITO-URINARY SYSTEM AND ANNEXA. 

Other diseases of the kid- 
neys and armexa. 

Calculi of the urinary pas- 
sages. 

Diseases of the bladder. 

Diseases of the urethra, 
urinary abscess, etc. 



99. 


Diseases of (the mouth 


109. 




and annexa. 


110. 


100. 


Diseases of the pharnyx. 




101. 


Diseases of the oesopha- 
gus. 


111. 


102. 


Ulcer of the stomach. 


112. 


103. 


Other diseases of the 






stomach. 


113. 


104. 


Diarrhoea and enteritis. 


114. 




(under 2 years.) ^ 


115. 


105. 


Diarrhoea and enteritis. 




106. 


Ankylostomiasis (Hook- 


116. 




worm.) 


117. 


107. 


Intestinal parasites. 


118. 


108. 


Appendicitis and typhlitis. 





119. 


Acute nephrits. 


122. 


120. 


Brieht's disease. Chronic 






Bright's disease, inter- 


123. 




stitial nephritis, Chronic 






parenchymatous nephri- 


124. 




tis, etc. 


125. 


121. 


Chyluria. 





CORRECT NAMES FOR CAUSES OF DEATH 



126. 


Diseases of the prostate. 


130. 


Other diseases of the 


127. 


Nonvenereal diseases of 




uterus. 




the male genital organs. 


131. 


Cysts and other tumors of 


128. 


Uterine haemorrhage. 




the ovary. 


129. 


Uterine tumor (noncan- 


132. 


Salpingitis. 




cerous.) 


133. 


Nonpuerperal diseases of 
the breast. 



VII.— THE PUERPERAL STATE. 



134. 



135. 
136. 



Accidents of pregnancy. 
Abortion, Criminal 

abortion, 
Miscarriage, 
Ectopic gestation, 
Tubal pregnancy, etc. 

Puerperal haemorrhage. 

Other accidents of labor. 
Caesarean section, 
Forceps application, 
Breech presentation, 
Symphyseotomy, 



137. 
138. 

139. 



140. 
141. 



Difficult labor. 

Rupture of uterus in 

labor, etc. 
Puerperal septicaemia. 
Puerperal albuminuria 

and convulsions. 
Puerperal phlegmasia al- 
ba dolens, embolus, 

sudden death. 
Following childbirth. 
Puerperal diseases of the 

breast. 



VIIL— DISEASES OF THE SKIN AND 
CELLULAR TISSUE. 



142. Gangrene. 

143. Furuncle. 

144. Acute abscess. 



145. 



Other diseases of the skin 
and annexa. 



IX.— DISEASES OF THE BONES AND OF THE 
ORGANS OF LOCOMOTION. 



146. Diseases of the bones. 
Osteoperiostitis. 
Osteomyelitis, 
Necrosis, 

Mastoiditis, etc. (Fol- 
lowing Otitis media.) 



147. 



148. 
149. 



Diseases of the joints. 
Acute articular rheuma- 
tism. 
Arthritis deformans, 
Tuberculosis of — joint. 

Amputations. 

Other diseases of the or- 
gans of locomotion. 



CORRECT NAMES FOR CAUSES OF DEATH 



61 



X.— MALFORMATIONS. 



150. Congenital malforma- 

tions. 

Congenital hydrocepha- 
lus, 



Congenital malforma- 
tion of heart, 
Spina bifida. 



XL— DISEASES OF EARLY INFANCY. 



151. Congenital debility, 
rus, and sclerema 
Premature birth, 
Atrophy, 
Marasmus, 
Inanition, etc. 



icte- 152. Other diseases peculiar to 

early infancy : 
Umbilical haemorrhage, 
Atelectasis, 

Injury by forceps at 
birth, etc. 
153. Lack of care. 



154. Senility. 



XII.— OLD AGE. 



XIII.— AFFECTIONS PRODUCED BY EXTERNAL 
CAUSES. 



155. Suicide by poison. 

156. Suicide by asphyxia. 

157. Suicide by hanging or 

strangulation. 
lo8. Suicide by drowning. 

159. Suicide by firearms. 

160. Suicide by cutting or 

piercing instruments. 

161. Suicide by jumping from 

high places. 

162. Suicide by crushing. 

163. Other suicides. 

164. Poisoning by food. 

165. Other acute poisonings. 

166. Conflagration. 

167. Burns, scalding. 

168. Absorption of deleterious 

gases : 

Asphyxia by illuminat- 
ing gas (accidental), 

Inhalation of — (ac- 
cidental), 

Asphyxia (accidental). 



169. 
170. 
171. 

172. 
173. 



174. 
175. 



Suffocation 
(accidental). 
Accidental drowning. 
Traumatism by firearms. 
Traumatism by cutting or 

piercing instruments. 
Traumatism by fall. 
Traumatism in mines and 



quarries : 
Fall of 



rock in coal 



176. 



mine, 
Injury by blasting, slate 
quarry. 
Traumatism by machines. 
Traumatism by other 
crushing. 
Railway collision, 
Struck by street car, 
Automobile accident, 
Run over by dray, 
Crushed by earth in 
sewer excavation, etc. 
Injuries by animals. 



62 



CORRECT NAMES FOR CAUSES OF DEATH 



177. 


Starvation. 


183. 


Homicide by cutting or 


178. 


Excessive cold. (Freeze 




piercing instruments. 




ing. 


184. 


Homicide by other means. 


170. 


Excessive heat. (Sun- 


185. 


Fractures. 




stroke. ) 


186. 


Other external causes : 


180. 


L'ghtning. 




Legal hanging, 


181. 


Electricity. 




Legal electrocution. 


182. 


Homicide by firearms. 








XIV.— ILL DEFIN 


"ED DISEASES. 


187. 


111 denned organic dis- 


188. 


Sudden death. 




eases : 


189. 


Ouse of death not speci- 




Dropsy, 




fied or ill defined. 




Ascites. 







CHAPTER VI 

DISINFECTION FOR THE COMMUNICABLE DIS- 
EASES. 

THE NON-CONTAGIOUS DISEASES. 

Anthrax. — This is a communicable disease occurring 
as a wide spread infection of the lower animals and occa- 
sionally communicated to man. This disease is often 
called malignant pustule, splenic fever, wool-sorter's dis- 
ease. 

The infection is introduced into the skin and a local 
reaction results causing the malignant pustule. The 
inflammation spreads through the lymphatics and invades 
the blood. When the infection is taken ink + he respira- 
tory tract it causes a violent inflammation resembling 
bronchitis or pneumonia, and is called wool sorter's dis- 
ease. Sometimes the infection is taken into the intestinal 
tract, producing symptoms of an intense poisoning. All 
the forms of this disease frequently result fatally. 

The disease is caused by the bacillus anthracis, which 
is one of the few disease producing germs that produce 
spores. 

The infection usually enters the system through As- 
sures, abrasions, or wounds of the skin, which is espe- 
cially apt to take place upon the exposed surface — the 
hands, face and arms — of those who work with hides and 

63 



54 DISINFECTION FOR COMMUNICABLE DISEASES 

other infected objects. The infection may also be taken 
into the digestive tract as a result of eating meat or 
drinking milk, of the diseased animal. The third channel 
through which the infection may enter the system is 
through the respiratory system. 

The infection of anthrax is eliminated from the body 
in the pus and discharges from the vesicles, carbuncles, 
and broken down tissue which are frequently found asso- 
ciated with the disease. The pulmonary form of the in- 
fection is eliminated from the body in the expectoration. 
In the intestinal variety the discharges from the bowels 
contain the infective agent. The infection has been con- 
veyed by flies probably in the same way that these in- 
sects spread the infection of typhoid fever. 

The bacillus of anthrax itself is readily killed, but the 
spores have a high degree of resistance to heat and chem- 
ical agents, so that much more powerful disinfectants are 
required for the non-spore bearing bacteria. The disin- 
fection of anthrax is one of the most difficult problems 
with which we have to deal. 

A dry heat of 100 degrees C. continued for one hour 
is necessary to kill spores. As far as moist heat is con- 
cerned, nothing less than boiling water or steam at 100 
degrees C. can be considered trustworthy, and then with 
an exposure of two hours. Anthrax spores may be killed 
with superheated steam with certainty and this is the 
most trustworthy method of dealing with the infection. 
An exposure to steam at 120 degrees C. for fifteen minutes, 
is quite sufficient. 

Formaldehyde gas and sulphurous acid gas are in- 
capable of destroying the infection with certainty and 



DISINFECTION FOR COMMUNICABLE DISEASES 65 

are therefore totally unreliable. A 1 :500 solution of bi- 
chloride of mercury acts more quickly and should be used 
in dealing with this infection. Carbolic acid can not be 
depended upon to destroy the spores of anthrax, and 
therefore is not applicable for disinfection against the 
disease. Tricresol in 2 per cent, solution or lysol in 2 
per cent, solution may be used. It requires a 33 per cent, 
solution of formalin (containing 40 per cent, formalde- 
hyde) to destroy anthrax spores in fifteen minutes. The 
strengths of the disinfecting solutions here given are 
based upon their germicidal action at ordinary tempera- 
tures. Their power is very much increased by using them 
hot, and it is recommended always to use these solutions 
at or as near the boiling point as possible. 

All bandages, dressings .and other objects of little 
value should be burned as the best means of disinfection. 
Bedding, clothing, and other objects that have become 
contaminated by the discharges, should be first placed in 
one of the germicidal solutions, for at least an hour and 
then boiled. 

The disinfection of cadavers or carcasses dead of an- 
thrax is a very important and difficult matter. The in- 
fection may live for years in the soil, which becomes 
contaminated from the bodies of animals even when deep- 
ly buried. The worms have been known to bring us the 
spores in their intestinal canal to the surface, thereby 
giving rise to fresh infection after the lapse of a very 
long time. Cremation is the best method of disposing 
of the bodies dead of anthrax. 

"When a body dies of this disease and it is to be shipped, 
it should be prepared according to Rule No. 2, of the rules 



66 DISINFECTION FOR COMMUNICABLE DISEASES 

and regulations of the boards of health and the baggage 
men's association. 

Epidemic Cerebro-Spinal Meningitis. — This is a com- 
municable disease occurring in very fatal epidemics. It 
is an inflammation of the meninges of the brain and the 
cord and gives rise to a great variety of symptoms. 

The cause of the infection is the meningococcus, or 
diplococcus intracellularis meningitidis. It has no spores. 
Little is known as to the spread of the disease. It is evi- 
dently not directly contagious from the sick to the well, 
nor is the infection transmitted upon the clothing. 

So little is known of the existence of the infection in 
nature outside of the body and the channels through 
which it gains entrance into the system that we can not 
apply our disinfectants with any assurance of limiting 
the spread of the disease. Our hope in a case like this 
is to practice a general disinfection of all the discharges, 
and all the objects that come in contact with the patient, 
and to give the room a general fumigation with formalde- 
hyde after the termination of the case. The windows 
should be screened against insects. In this way all the 
known principles of disinfection are applied with the 
expectation that one will do the work. The embalmer 
should spray his nose and mouth with an alkaline-oil solu- 
tion, which can be furnished by any druggist. Spraying 
should be done before embalming and after the process 
of embalming has been completed. 

"When a body dies of this disease and it is to be 
shipped, it should be prepared according to Rule No. 2, 

Erysipelas. — Erysipelas is a communicable disease, 
sometimes occurring in epidemics. It is characterized by 



DISINFECTION FOR COMMUNICABLE DISEASES 67 

a special inflammation of the skin, with a fever and all 
the characteristics of an acute infection. 

The period of incubation is usually from three to seven 
days. 

The cause of the disease is the streptococcus erysipe- 
latis, or the streptococcus pyogenes. Fehleisen first ob- 
tained this organism from the skin of cases of erysipelas 
in 1883. This organism does not have spores. It is al- 
ways found in the inflamed region, especially in the 
spreading zone of the inflammation. The organism usu- 
ally remains localized at the seat of the lesion, but it 
may invade the blood and with its toxin give rise to 
serious and often fatal complications. 

It is believed that the infection of erysipelas always 
enters the system through the wounds in the skin or mu- 
cous membranes. These wounds may be such slight fis- 
sures or abrasions as not to be visible to the naked eye. 

The infection is eliminated from the body in the pus 
and secretions from the seat of the inflammation and 
perhaps also in the desquamating skin from the inflamed 
area. Outside the body the streptococcus of erysipelas is 
a very frail organism. It dies and loses its virulence 
very quickly when dried, especially in the sunshine. It 
is very susceptible to heat and to antiseptics. It is killed 
by a moist temperature of between 52 and 54 degrees C. 
in ten minutes. Boiling water or steam at a temprature 
of 100 degrees Centigrade destroys the infection at once. 

Formaldehyde and sulphurous acid gas are very effi- 
cient gases to employ for fumigation where erysipelas 
has been, and should be used in the strengths and time 
as stated for these chemicals. 



68 DISINFECTION FOR COMMUNICABLE DISEASES 

The germ is also destroyed by the ordinary germi- 
cidal solutions in the strengths for the destruction of the 
non-spore-bearing germs, as for example, bichloride of 
mercury 1 : 1000, carbolic acid 3 to 5 per cent., tricresol 
1 per cent., formalin 3 to 5 per cent. 

The bandages and other dressings from a case of 
erysipelas should be burned or thoroughly boiled. The 
bedding, towels, and other fabrics that have come in con- 
tact with the patient, or the infection must be boiled, 
steamed or immersed in one of the germicidal solutions. 
The hands of the nurse, and all objects that have in any 
way come in contact with the infected secretions must 
be disinfected by the methods appropriate for each object. 

Rooms that have become contaminated with the in- 
fection of erysipelas, should be given a disinfection with 
one of the gases, followed by a thorough cleansing. 

When a body dies of this disease and it is to be shipped, 
it should be prepared according to rule No. 2 of the rules 
and regulations of the boards of health and the baggage 
men's association. 

Glanders. — This is a widespread, communicable dis- 
ease of horses, mules, asses, and other animals. It is occa- 
sionally communicated to man. In both man and horses 
it is remarkable for its fatality. 

The disease is characterized by the formation of in- 
flammatory nodules, either in the mucous membranes of 
the nose (glanders), or in the skin (farcy). The period 
of incubation is from three to four days. 

The cause of this disease is the bacillus mallei, which 
does not have spores. 

The infection may be introduced into the system either 



DISINFECTION FOR COMMUNICABLE DISEASES 69 

through the skin or the mucous membranes of the res- 
piratory tract. In the former case the disease is usually 
communicated from the horse to man by contact with 
the infected discharges, which gain entrance into the sys- 
tem through wounds in the skin, giving rise to the form 
of infection known as farcy. The disease may also be 
communicated from man to man. 

The inflammatory processes which characterize the 
disease have a tendency to break down, causing ulcers 
and abscesses, and the infection is eliminated from the 
body in the pus and the secretions from the seat of the 
lesions. 

The manner of disinfection would be the same as that 
described for diphtheria and tuberculosis and need not 
be repeated here. 

When a body dies of this disease and it is to be shipped, 
it should be prepared according to rule No. 2 of the rules 
and regulations of the boards of health and the baggage 
men's association. 

Gonorrhea. — There is a specific inflammation of the 
mucous membrane of the urethra in the male and of the 
urethra, cervix uteri, and the glands of Bartholini in the 
female. This disease is caused by a micrococcus discov- 
ered by Neisser, and commonly known as the "gonoeoccus 
of Neisser. " 

When kept at body temperature artificial cultures of 
this organism have been observed to retain their vitality 
for as long as a month ; whereas at ordinary room tem- 
perature they die in about forty-eight hours. The germ 
is destroyed in a few hours by drying. The germ is non- 
pathogenic for animals. 



70 DISINFECTION FOR COMMUNICABLE DISEASES 

"When a body dies with this disease, or some other dis- 
ease, but there is evident signs of gonorrhea, the body 
should be washed off with a bichloride of mercury solu- 
tion, of a 1 : 1000 strength, and pay special attention to 
the genitalia, to see that they are well disinfected. It is 
best to use rubber gloves in handling a case where gonorr- 
hea is present. 

When a body dies of this disease and it is to be shipped 
it should be prepared according to rule No. 3. 

Hydrophobia. — A specific infectious disease communi- 
cable from animals to animals and from animals to man, 
commonly by a bite. 

In animals this disease is known as rabies, while in 
man it is known as hydrophobia. 

The period of incubation of hydrophobia ordinarily 
varies from about six weeks to two months according to 
circumstances. 

The preventive treatment is (1) the immediate de- 
struction of. all dogs known to be suffering from this 
disease, and the isolation and careful observation of all 
animals that may have been bitten by such dogs. 

(2) The seizure and destruction of all vagrant dogs. 

(3) The imposition of a tax on all dog owners. 

(4) The compulsory muzzling of all dogs during the 
prevalence of this disease. 

(5) Preventive inoculation. 

When handling a subject that has died of this dis- 
ease, the embalmer should see that the blood which may 
be drawn from a body is disinfected, and should wear 
rubber gloves, to prevent any poison getting into his 
system through an abrasion of the skin, or an accidental 
cut. 



DISINFECTION FOR COMMUNICABLE DISEASES 71 

When a body dies of this disease and is to be shipped 
it should be prepared according to Rule No. 3. 

Relapsing Fever. — This disease, sometimes called fam- 
ine fever, or seven-day fever, is a communicable disease 
and sometimes epidemic in form. The disease is common 
in India, and has from time to time extended into Eu- 
rope. In 1869 it prevailed as an epidemic in New York 
and Philadelphia, but since then has not occurred in epi- 
demic form in this country. 

The disease is characterized by sudden onset with a 
chill, followed by a fever lasting about one week. There 
is then an intermission of about the same length of time, 
only to be followed by a repetition of the first febrile 
paroxysm. These relapses, from which the disease takes 
its name, may repeat themselves as many as five times. 

The incubation period is from five to seven days. 

Relapsing fever is caused by the spirochaeta Ober- 
meieri, discovered by Obermeier in 1873. 

The channels of entrance into and elimination from 
the body are not known. In this disease, as with typhus 
fever, sanitation seems to be more important than disin- 
fection. 

When a body dies of this disease and is to be shipped, 
it should be prepared according to Rule No. 3. 

Syphilis. — This is a chronic, infectious disease, char- 
acterized by manifold pathological lesions, of which the 
chancre, the mucous patch, and the gumma are the most 
destructive. 

The cause of the disease is said to be the spirochaete 
pallida, a very small spiral-shaped organism. 

In a vast majority of cases, both gonorrhea and syph- 



72 DISINFECTION FOR COMMUNICABLE DISEASES 

ilis are disseminated through actual contact with the se- 
cretions of diseased tissue during sexual intercourse. 
Syphilis may be disseminated, in addition to the usual 
way, through kissing and through the use of drinking and 
.eating utensils that have been used by persons suffering 
from syphilitic lesions of the mucous membranes of the 
mouth. The embalmer may contract this disease in the 
handling of his subject. 

After death the body should be thoroughly washed 
with a bichloride of mercury solution at least 1 : 1,000 in 
strength, and the operator should use rubber gloves while 
handling and operating on the subject. 

When a body dies of this disease and is to be shipped, 
it should be prepared according to Rule No. 3. 

Tetanus. — Tetanus is a communicable disease, preva- 
lent in certain localities, and sometimes occurring in 
epidemic form in institutions, camps, or among the newly- 
born children. 

The disease is characterized by cramps of the volun- 
tary muscles, beginning with the muscles of the jaw, 
which gives the name of lockjaw or trismus to the af- 
fection. 

The period of incubation is usually within ten days. 

This disease is caused by the tetanus bacillus, first is- 
olated by Kitasato in 1889. It has spores, which are 
usually small, round and appearing upon one end of the 
bacillus, and giving it the shape of a pin. The spores 
become detached from the bacilli, and have an independ- 
ent existence and a very high degree of resistance to heat, 
germicidal agents and external influences. Under favor- 
able conditions, such as the presence of moisture and albu- 



DISINFECTION FOR COMMUNICABLE DISEASES 73 

urinous matter and the absence of oxygen, the spores are 
capable of germinating into bacilli. 

The disease is always contracted through wounds, 
which may be of trifling nature. Deep or punctured 
wounds are more apt to develop tetanus, because the 
oxygen of the air prevents the deyelopment and activity 
of the organism should it lodge upon the surface. There 
is very little reaction or inflammation set up at the seat 
of the inoculation. The organism germinates and multi- 
plies locally in the wound without invading the blood or 
the deeper tissues. 

The symptoms of the disease result from the forma- 
tion of a poison called the tetanus toxin, which is ab- 
sorbed into the system and produces its baneful action 
upon the nervous matter. The toxin of tetanus, which 
is produced by the growth and multiplication of the 
bacillus within and without the body, is one of the most 
violent poisons known. An infinitesimally small amount 
is sufficient to kill a susceptible animal. 

The infection is eliminated from the body in the pus 
and discharges from the wound. The infection is kept 
alive and spread, largely owing to the fact that many of 
the lower animals, particularly horses, are susceptible to 
the disease. The spores are taken with the hay, grass and 
other food of these animals into their intestinal canals, 
where they germinate and multiply in great numbers, 
and are passed out in the manure. In this way the soil 
of most inhabited localities becomes contaminated with 
the infection. 

The disinfection of tetanus resolves itself into the 
destruction of the spores. In general, the degree of re- 



74 DISINFECTION FOR COMMUNICABLE DISEASES 

sistance of these spores resembles those of anthrax very 
closely, and the methods of disinfection are the same. 

Tetanus spores retain their vitality for months in the 
soil, in manure and in putrefying materials. A dry heat 
of 150 degrees, continued an hour, is necessary to kill 
them with certainty. 

They withstand a moist temperature of 80 degrees C. 
for one hour, but are killed by boiling water or by steam 
at 100 degrees C. in a few minutes. In actual practice it 
is necessary to expose objects to boiling or to steam no 
less than two hours in order to insure perfect penetra- 
tration and the destruction of the spores. 

Steam under pressure is the most reliable disinfectant 
agent we possess for this resistant infection. An expos- 
ure of fifteen minutes to steam at a temperature of 120 
degrees C. will surely kill the spores. 

A 5 per cent, solution of carbolic acid requires fifteen 
nours to kill tetanus spores, and is therefore inapplicable 
as a disinfectant for the disease. Tricresol or lysol in 2 
per cent, solutions may be used with an exposure of two 
hours. 

The spores show a high degree of resistance to a 1 : 
1,000 solution of bichloride of mercury. In actual prac- 
tice a 1 : 500 solution should be used. 

Germicidal solutions are so much more powerful when 
used hot that it is strongly recommended to use them at 
or near the boiling point. 

Formaldehyde gas and sulphurous acid gas can not 
be depended upon to destroy tetanus spores, and are 
therefore totally inapplicable as disinfectants for the 
disease. 



DISINFECTION FOR COMMUNICABLE DISEASES 75 

When a body dies of this disease and is to be shipped, 
it should be prepared according to Rule No. 3. 

Actinomycosis. — A disease of man and some of the 
lower animals, especially cattle, horses and pigs. This 
affection is sometimes called big jaw, lumpy jaw and 
wooden tongue. 

There is an intense inflammation of the tongue, the 
lips, cheeks, bones, lungs, skin and other tissues of the 
body. The cause of this disease is the ray fungus, the 
actinomyces. It is not known how the organism enters 
the system. 

The sputum and the dejecta in the abdominal cases 
should be disinfected and bandages and other objects 
that have become soiled with the discharges should be 
burned or disinfected with steam or boiling water. 

When a body dies of this disease and is to be shipped, 
it should be prepared according to Eule No. 3. 

Dengue. — A communicable disease, occurring in epi- 
demic form in the tropical regions. The disease is char- 
acterized by pain in the joints and fever, and sometimes 
a rash. The cause of this disease is not known. The 
period of incubation is from three to five days. 

The disease spreads from place to place along the 
lines of travel. The disease is not known to be conta- 
gious although it is remarkable in attacking all the 
members in a community, whether they have come in 
contact with the sick or not. It spreads over a great ex- 
panse of territory in a short time. 

It is not known how the infection leaves the body or 
the channels of infection, and it is not known that the dis- 



76 DISINFECTION FOR COMMUNICABLE DISEASES 

ease has ever proved fatal. For this reason it is not so 
necessary for the embalmer to know ranch about the 
disease, as disinfection is not practiced to check the 
spread of this disease. 

When a body dies of this disease and is to be shipped, 
it should be prepared according to Rule No. 3. 

Dysentery. — Dysentery is a communicable disease, 
occurring in widespread epidemics with great fatality, 
especially in the tropics and warm climates. The dis- 
ease is characteried by an inflammation of the lower 
bowel, accompanied with frequent and painful stools, 
often bloody. The symptoms of dysentery may result 
from one of many different poisons, but the communica- 
ble dysentery is a specific disease, due to a definite, living 
entity, the bacillus dysenteric, described by Shinga in 
1899. It is a short, actively motile rod, closely resembling 
the bacillus of typhoid fever. 

The bacillus of dysentery does not have spores. 

It is believed that dysentery is transmitted in very 
much the same way as typhoid fever. The cause of the 
disease is taken into the intestinal tract usually with the 
drinking water. The milk and food may also convey the 
infection. As the poison is excreted from the body in 
the evacuation from the bowels, it is reasonable to sup- 
pose that the flies and ether insects may play a part in 
the dissemination of the infection. 

The vitality of the bacillus of dysentery is precisely 
similar to that of typhoid fever, and the principles of dis- 
infection are the same, so that it is not necessary to re- 
peat them here. 

Another form of the communicable dysentery preva- 



DISINFECTION FOR COMMUNICABLE DISEASES 77 

lent in the tropical and warm climates is believed to be 
due to a protozoon — the amoebae dysenteriae. This form 
of the disease is usually chronic, and, so far as known, the 
same methods of prevention and disinfection are applica- 
ble to it as to the above. 

When a body dies of this disease and is to be shipped 
it should be prepared according to Rule No. 3. 

Malaria. — Malaria is a communicable disease of great 
widespread in many parts of the world. 

The disease is due to a minute animal parasite, the 
Haematazoa malaria, discovered by Laveran in 1880. The 
malarial organism is found in the blood, spleen and other 
organs of the body in all cases of the disease. 

Malarial infections are conveyed from the sick to the 
well by the mosquito. The insect takes the parasite into 
its stomach along with the drop of blood. In the mosquito 
the parasite passes through a long and complicated series 
of changes, taking about twelve days from the time it 
drinks the malarial blood until it is capable of transmit- 
ting the infection by biting another person. From the 
stomach of the mosquito the parasite passes into the gen- 
eral body cavity of the insect and finally appears in the 
salivary glands. These glands excrete the poison that is 
injected through the proboscis of the insect into the skin 
of the person it bites, and it is in this way that the 
malarial parasites are inoculated into the system. 

Malaria is primarily a blood infection. Not all mos- 
quitoes are capable of transferring the infection of the 
malarial diseases. It is only a certain variety known as 
the Anopheles that is endowed with this special property. 
Of this variety only the female insect is capable of trans- 



78 DISINFECTION FOR COMMUNICABLE DISEASES 

mitting the disease. After feeding upon blood it lays its 
eggs upon the surface of the water. In a few days, de- 
pending upon the temperature and other conditions, each 
egg hatches a larva, and this develops into a pupa. The 
larvae and pupae, commonly known as wigglers, must 
come to the surface of the water to breathe. To kill 
these embryonic forms a thin layer of oil is placed on 
the surface of the water. 

It is plain, therefore, that the disinfectant for malaria 
must be directed against the mosquito. Patients infected 
with malaria must be protected with mosquito netting in 
order to prevent the spread of the infection. For those 
individuals residing in the malarial districts, a precau- 
tion would be to sleep in rooms thoroughly screened 
against the mosquitoes, and in this way escape infection. 
The mosquitoes found in the room of the sick and the 
w^ell should be destroyed. For this purpose pyrethrum, 
sulphurous acid gas, tobacco smoke and the other insecti- 
cides mentioned in Chapter XXI, may be used. The 
extermination of the mosquito would mean the extermi- 
nation of malaria as far as man is concerned. 

It is evident that insecticides and not germicides are 
wanted to combat this disease. 

When a body dies of this disease and is to be shipped, 
it should be prepared according to Rule No. 3. 

Yellow Fever. — Yellow fever has its home in the West 
Indies, Central America and the west coast of Africa. 
From these epidemic foci in the tropics it spreads from 
time to time to the temperate zones, where it occurs in 
epidemic form, sometimes with great mortality. It is an 
acute febrile disease, characterized by congestion, jaun- 



DISINFECTION FOR COMMUNICABLE DISEASES 79 

dice, vomiting, prostration and albumin in the urine. The 
vomited matter is often of a dark brown or black color, 
the so-called black vomit. 

The period of incubation is from two to three days, 
rarely over five. A certain species of mosquito called the 
Stegomyia fasciata, after biting the patient, takes the 
infected blood into its stomach. The mosquito itself be- 
comes infected, and after a lapse of twelve days can 
communicate the disease by biting another person. Here 
again, as in the case of malarial fever, the female mos- 
quito is responsible for the spread of the disease, and in 
as much as the mosquito lives in the water during its 
early existence, as a larva, this gives us a keynote for its 
extermination. A thin layer of oil should be placed over 
all surface water, so as to kill the embryonic forms. 
Rooms should be carefully screened, so as to exclude the 
mosquito. Insecticides, and not germicides, are wanted. 
Wherever mosquitoes are found in the bedroom they 
should be killed by either burning pyrethrum, sulphurous 
acid gas, tobacco smoke, formaldehyde, or one of the in- 
secticides known to be fatal to these insects. 

A body dying of this disease that is to be shipped, 
should be prepared according to Rule No. 2 of the rules 
and regulations adopted by the health boards and bag- 
gage men's association. 



CHAPTER VII. 

DISINFECTION FOR THE COMMUNICABLE DIS- 
EASES.— Continued. 

THE SLIGHTLY CONTAGIOUS DISEASES. 

Diphtheria. — Diphtheria is a communicable disease, 
occurring in severe epidemics among the children. 

It is characterized by an inflammation of the mucous 
membrane, especially of the throat. The character of 
this inflammation varies very much in degree. It 
may resemble the simple catarrhal inflammation resulting 
from "catching cold" or when more severe may cause a 
fibrinous deposit or false membrane, by which the disease 
has long been recognized clinically. Every degree of se- 
verity is met with, from the mildest type to the malignant 
variety that results fatally in a few hours. 

Diphtheria is not confined to the throat, but may at- 
tack any of the mucous membranes of the body, including 
the conjunctiva. The disease may also complicate wounds, 
and open sores may be the seat of a typical attack of diph- 
theria, accompanied with false membranes and all the 
constitutional manifestations of the disease. 

The period of incubation is from two to seven days. 

The cause of diphtheria is the bacillus diphtheria, first 
seen by Klebs under the microscope in 1883 and isolated 
80 



DISINFECTION FOR COMMUNICABLE DISEASES — CONT. 81 

in pure culture the next year by Loeffler, who proved this 
organism to be the cause of the disease. 

The bacillus of diphtheria is a non-motile rod of varia- 
ble length and very irregular shape. It is often swollen 
on one end, presenting a club-shaped appearance, or it 
may be pointed or wedge-shaped. It stains in an irregu- 
lar manner with the basic aniline dyes that is quite char- 
acteristic. The bacillus of diphtheria grows well upon 
blood serum and artificial culture media, at the tempera- 
ture of the body. 

It does not have spores. 

The infection may enter the body in a variety of ways. 
It may pass directly from mouth to mouth, or indirectly 
from objects that have become infected with the germs 
of the disease. The bacilli may be taken into the body 
with the food, especially milk. The infection may also 
be taken into the body through the respiratory system, 
although this is rare. The diphtheria bacillus is not found 
in the expired breath and the disease is not air-borne in 
the sense that smallpox or typhus fever is. The air may 
become infected from dried sputum, or from minute par- 
ticles that are sprayed from the mouth in the acts of 
coughing, speaking, gagging, and other acts of expira- 
tion accompanied with explosive movements. The in- 
fection may also be inoculated into the wounds of the 
skin. When the diphtheria bacillus enters the mouth or 
lodges upon the mucous surfaces, it grows and multiplies, 
setting up local inflammation which characterizes the dis- 
ease. The organism usually remains localized at the seat 
of the lesion, and rarely invades the deeper tissues or the 
blood. 



i 



82 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

During the course of its growth and multiplication 
the diphtheria bacillus produces a chemical poison — the 
diphtheria toxin. It is really this toxin ,and not the 
bacillus itself that causes the local inflammation and the 
fibrinous exudate with the death of the cells, resulting in 
the production of the false membrane. This toxin is a 
soluble poison and is readily absorbed into the system 
resulting in fever, prostration, and the nervous symptoms 
that frequently are associated with diphtheria. 

The bacillus of diphtheria is eliminated from the body 
with the secretions from the mucous membranes, or with 
the pus and exudates from wounds, depending upon the 
seat of the local lesion. The membranes of the throat and 
larynx being the usual seat of the disease, the infection 
is most commonly thrown off from the body in the ex- 
pectoration. Therefore the sputum, and all objects which 
come in contact with the secretions of the mouth must be 
carefully disinfected in order to prevent the spread of the 
infection. 

The evacuations of the bowels and the urine do not 
need disinfecting in this disease. 

It has been found that many persons in good health 
have live and virulent diphtheria bacilli in the secretions 
from their mouths ; that is, the organism may grow upon 
the mucous membranes of the throat and be contained in 
the expectoration without causing the least inconvenience. 
Such persons are a constant menace to others who are 
more susceptible to the disease. 

The infection may be spread from mouth to mouth by 
kissing, or indirectly, by any object that becomes contami- 
nated with the infected secretions. Handkerchiefs, towels, 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 83 

and other fabrics are especially apt to become infected 
and unless disinfected become sources of danger. Knives, 
forks, spoons, and other tableware that come in contact 
with the mouth may carry the infection to other persons 
who use such articles without previous scalding or dis- 
infection. Toys are often responsible for the spread of 
the disease, on account of the habit children have of put- 
ting such toys in the mouth. 

The bacillus of diphtheria grows well in milk, and 
epidemics of the disease have been traced to this source. 
The milk is usually infected at the dairy, but may be ren- 
dered safe by boiling or pasteurization. 

The bacillus of diphtheria is readily killed by heat or 
chemicals. It is destroyed by a moist temperature of 58 
degrees C. in a few minutes. Boiling water at 100 de- 
grees C. will destroy the vitality of the infection instantly. 
It is to be noted that while the bacillus usually dies 
quickly when dried, under certain circumstances it may 
retain its vitality for a very long time, especially if dried 
in albuminous matter, such as little bits of false mem- 
brane. This accounts for the long time the infection may 
exist upon objects that have become contaminated with 
the secretions of the mouth. 

The direct sunlight will kill cultures in from thirty to 
forty minutes. 

Any of the germicidal solutions, employed in the 
strengths stated for the disinfection of non-spore bearing 
bacteria, are efficient for the bacillus of diphtheria ; for 
example, bichloride of mercury 1 :1000, carbolic acid 3 to 
5 per cent., tricresol 1 per cent., formalin 3 to 5 per cent. 

Formaldehyde gas kills the bacillus of diphtheria at 



84 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

once, when used in the proper strength as stated on page 
154, if the bacteria are exposed directly to the gas. An ex- 
posure of twenty-four hours is advisable in order to in- 
sure diffusion and penetration, for the bacilli are not al- 
ways directly exposed to the action of the gas, but are 
encased in the mucoid and albuminous matter of the se- 
cretions. 

Sulphurous acid gas is also an efficient disinfectant, 
but is limited in its practical application on account of its 
destructiveness. 

Sputum should be treated as specified on page 265. 
Towels, bedding, linens, and other fabrics that have come 
in contact with the patient should be boiled, steamed, or 
immersed in one of the chemical solutions. 

If the patient recovers from the disease, the room 
should have a general disinfection with one of the gases 
recommended, in order to destroy the infection that may 
have become diffused throughout the room. 

If the patient dies the room disinfection should be 
carried out, the body thoroughly disinfected and great 
care should be taken to see that everything is disin- 
fected as though the patient had lived, for the safety of 
others. (See Chapter XXIV). 

Bodies dying of this disease which are to shipped 
should be prepared according to Rule No. 2 of the rules 
and regulations of the boards of health and baggagemen's 
association. 

Tuberculosis. — Tuberculosis, known as the great white 
plague, is a communicable disease prevalent in all parts 
of the world. 



DISINSECTION FOR COMMUNICABLE DISEASES— CONT. 85 

It is caused by the tubercle bacillus, discovered by 
Robert Koch in 1881-1882. 

The tubercle bacillus may attack almost every organ 
and tissue of the body. Tuberculosis of the lungs is com- 
monly called consumption or phthisis ; of the lymphatic 
glands it is called scrofula ; of the skin it is called lupus. 

The tubercle bacillus does not have spores. 

It is more resistant to heat and other external in- 
fluences than other bacilli. It has been kept alive in 
sputum three years, at the end of which time it was still 
virulent. 

Tuberculosis is spread from person to person and from 
animals to man in a variety of ways. The infection may 
be breathed into the lungs with the dust, may be taken 
into the alimentary canal with the food or drink, or may 
be inoculated into the system through wounds of the 
skin or mucous membranes. When the tubercle bacillus 
gains entrance into the tissues, it gives rise to a charac- 
teristic form of inflammation which expresses itself in the 
formation of little grayish nodules, called tubercles. 

The tubercle bacillus is eliminated from the body in 
the pus and matters discharged from the processes of 
destructive inflammation. As the lungs are more fre- 
quently attacked than any other organ, the infection is 
commonly thrown off in the expectoration. The disease 
is largely spread by the dried sputum which floats about 
the air as dust and is breathed into the respiratory tract 
of susceptible persons. Kissing may also spread the bacilli 
from mouth to mouth, and consequently no one, on no 
account, should ever be allowed to kiss a corpse. Table- 
ware used by a consumptive is one of the means of con- 



86 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

veying the infection to healthy persons if such ware is 
used without previous boiling or disinfecting. 

Many of the lower animals, especially the cow, are sus- 
ceptible to tuberculosis, and there is little doubt but that 
the disease is spread to man through the agency of infected 
meat and milk. Tuberculous meat is rendered safe by 
thorough cooking, and milk is rendered safe by the well- 
known process, called pasteurization, which consists of 
heating it to 70 degrees C. for half an hour and then 
chilling it suddenly. 

The tubercle bacillus may be killed by boiling water 
or steam at a temperature of 100 degrees C. Drying has 
little effect on the bacillus, which accounts for the dan- 
gerous nature of dried sputum. It is not killed by freez- 
ing. The bright sunshine will kill the organism in a few 
hours, if it is exposed directly to the rays of the sun and 
provided the sputum is not too thick. The chemical solu- 
tions in the strength given for non-spore bearing bacteria 
are efficient disinfectants for the bacillus of tuberculosis, 
provided there is direct contact between the germ and the 
chemical solution; for example, bichloride of mercury 
1 : 1000, carbolic acid 5 per cent., tricresol 1 per cent., 
formalin 5 per cent., lysol 2 per cent. 

When the germs are embedded in the sputum, disin- 
fection will be found comparatively difficult on account 
of the albuminous nature of the sputum. For sputum, 
bichloride of mercury is totally inapplicable, because it 
is precipitated by the albuminous matter which it coag- 
ulates, preventing penetration. Carbolic acid also coagu- 
lates albuminous matter, though less actively than bi- 
chloride of mercury, and is therefore a very untrustwor- 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 87 

thy agent for the disinfection of sputum. A strong solu- 
tion of formalin 15 to 20 per cent., or tricresol 2 per cent., 
or lysol 2 per cent., may be used to disinfect small quan- 
tities of sputum, provided they are thoroughly incorpor- 
ated throughout the mass and allowed to stand no less 
than one hour. The best way to effectively dispose of 
sputum is by burning. 

For fumigation purposes, either formaldehyde or sul- 
phurous acid gas will kill this bacillus in the strengths 
stated in Chapter XV. An exposure of no less 
than twelve hours to formaldehyde and twenty- four hours 
to sulphurous acid gas is desirable. 

The disinfection of fabrics and other objects that have 
become contaminated with the tubercle bacilli does net 
differ from the methods given for the disinfection of 
such materials for other non-spore bearing infections, such 
as typhoid fever, diphtheria, pneumonia, etc., and need 
not be repeated here. 

When a body dies of this disease and is to be shipped 
it should be prepared according to Rule No. 3. 

Typhoid Fever. — Typhoid, or enteric fever, is a wide- 
spread communicable disease, frequently occurring in se- 
vere epidemics. 

The symptoms of the disease are very inconstant. A 
typical case is marked by a continued fever lasting about 
four weeks, a rose colored eruption, diarrhea, abdominal 
tenderness, tympanites, and enlargement of the spleen. 

The period of incubation is variously stated from 
eight to fourteen days, sometimes twenty-three. 

The cause of typhoid fever is a short, actively motile 
rod called the bacillus typhosis, sometimes called the 



88 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

Eberth bacillus, in honor of its discoverer, who described 
the organism in 1880. 

The bacillus of typhoid fever does not have spores. 

The organism is taken into the mouth, passes into the 
intestinal canal, where under favorable conditions it 
grows and multiplies, invading the system, giving rise to 
the lesions and the symptoms of the disease. A catarrhal 
condition exists throughout the small and large intes- 
tines, and the lymph follicles become swollen, hyperplas- 
tic, and may ulcerate. The bacillus is readily found in the 
inflamed lymphoid tissue, also in the rose-colored erup- 
tion, the enlarged spleen, and mesenteric glands. The 
bacillus frequently invades the blood, and may be found 
widely disseminated throughout the organs and tissues of 
the body. 

The typhoid bacillus produces a soluble poison in the 
course of its growth, called typho-toxin. It is this poison 
which is largely responsible for the fever, the inflamma- 
tion of the lymphoid elements of the body, the effect upon 
the heart and nerves, and the more serious features of the 
disease. 

The bacillus oi typhoid fever is eliminated from the 
body in the stools, the urine, and sometimes in the sputum, 
so that practically all the discharges from the body may 
contain the infective agent and must be disinfected in 
order to prevent the spread of the disease. 

The discharges from the patient contaminate the 
water, the milk, and the food supply. It is largely in this 
way that the disease is spread from the sick to the sound. 
Typhoid fever may be communicated through the me- 
dium of articles of diet other than the water and the 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 89 

milk. For instance, green vegetables, such as salads, 
radishes, celery and the like, that are eaten without pre- 
vious cooking, may be contaminated with infected water 
or soil that has been fertilized with the human manure. 
Raw oysters have also been known to set up several small 
epidemics of the disease. 

There is little evidence to show that typhoid fever is 
air-borne, or that the infection is, as a rule, taken into 
the system in any other way than by the mouth. This 
is a very important fact in applying our disinfecting 
agents for the suppression of the infection. It is true 
that pulmonary forms of the disease without intestinal 
lesions have been reported, but such instances seem to be 
exceptional. 

Flies are responsible for much of the spread of typhoid 
fever. They breed in and feed upon the dejecta and the 
infected discharges, thereby conveying the infection di- 
rectly, to the food-supply. It is easy to understand how 
flies, and other insects with similar habits, carry the ty- 
phoid bacilli smeared upon their feet and bodies, as well 
as in their intestinal contents, thereby contaminating the 
meat, the butter, and other foods, especially the milk, in 
which this organism grows so well. A can of milk con- 
taminated with a few typhoid bacilli may, in a few hours, 
at ordinary temperature, be teeming with the infection, 
without producing any apparent change in the milk. 

Flies, by alighting upon our lips or other portions of 
our body, may be the means of introducing the infection 
more directly into our mouths. The importance which 
flies play in spreading the infection of typhoid fever is 
not realized. This factor must always be taken into ac- 



DO DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

count in applying our disinfectants and other means to 
limit the spread of the infection. 

The typhoid bacillus is a hardy organism. It is found 
in the water, the' soil, the air, the dust, sewage and in the 
milk, as well as upon solid clothing, etc., contaminated 
directly or indirectly by the discharges of the sick. It 
finds abundant conditions in nature for its growth and de- 
velopment and enjoys the power of accommodating itself 
more readily to environment than the majority of the pa- 
thogenic bacteria. For instance, the addition of from 0.1 
to 0.2 per cent, of carbolic acid to the culture media does 
not retard its growth and development. It may retain its 
vitality for three months in distilled water, which indi- 
cates what a minute amount of organic matter is neces- 
sary for the life of the typhoid bacillus. 

A moist temperature of 60 degrees C. will kill the 
bacillus of typhoid fever in ten minutes, and boiling water 
or steam at a temperature of 100 degrees C. will destroy 
the vitality of the bacillus at once. It usually dies quickly 
when dried, although it has been kept alive several months 
on fabrics. It is apparently not affected by freezing. It 
soon dies when exposed to the bright, direct rays of the 
sun. 

Formaldehyde and sulphurous acid gas will kill this 
bacillus in the strengths and times stated for the employ- 
ment of these gases. 

All the ordinary germicidal solutions in the strengths 
given for the destruction of non-spore-bearing bacteria 
are efficient disinfectants for the typhoid bacillus : for ex- 
ample, bichloride of mercury 1 :1000, carbolic acid 3 to 5 
per cent., formalin 3 to 5 per cent., tricresol 1 per cent., 
etc. 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 91 

The disinfection for typhoid fever begins with the de- 
struction of the infection in the discharges as they leave 
the body, before they have a chance to contaminate the 
surroundings, the water or food supply. 

The evacuation from the bowels should be received in 
a vessel containing a 5 per cent, solution of carbolic acid, 
2 per cent, tricresol, or 5 per cent, formalin. More of the 
solution must be added afterward so that it is present in 
equal volume and thoroughly incorporated throughout 
the mass. The mixture should stand one hour before it 
is disposed of. Bichloride of mercury is not suitable for 
the destruction of the infection in the dejecta on account 
of its property of coagulating and combining with the 
albuminous matter, which prevents its penetration. Lime 
and its various compounds are cheap and efficient disin- 
fectants for this purpose and the methods for their use 
are given on page 181. 

The urine frequently contains the infective agent of 
the disease and is usually disinfected with the evacua- 
tions from the bowels. If passed separately it may be dis- 
infected by adding sufficient bichloride of mercury to 
make a 1 :1000 solution, or carbolic acid 3 to 5 per cent., 
tricresol 1 per cent., or formalin 3 to 5 per cent., and al- 
lowed to stand one hour before it is discarded. 

The sputum will also need treatment as it frequently 
contains the typhoid bacillus. The proper methods of dis- 
infecting the sputum have been given upon page 265 and 
need not be repeated here. 

All materials that have become contaminated from a 
case of typhoid fever must be disinfected by appropriate 
methods. This applies especially to the towels, bedding, 



92 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

and other fabrics used about the case. As boiling water 
or steam destroys the vitality of the typhoid bacillus in- 
stantly, either of these methods is particularly applicable 
to the disinfection of objects of this class. If the bedding 
is not soiled it may be immediately boiled, otherwise it 
must be treated so as to take out the albuminous mate- 
rials in order to prevent indelible staining, resulting from 
the coagulation and fixing of these materials in the fabric. 

The bedding and fabrics contaminated with the infec- 
tion of typhoid fever may also be disinfected by immer- 
sion in one of the germicidal solutions mentioned above. 

The bedding should be changed frequently and every- 
thing about the sick-room kept clean and fresh. The room 
should be well ventilated and the floor and surfaces kept 
clean and fresh and free from infection by frequent mop- 
ping with a 1 :1000 bichloride solution; The patient him- 
self will need scrupulous attention and careful nursing 
in order to keep his skin clean. The mouth and lips need 
frequent washing with listerine, boracic acid, or other 
mild antiseptic solutions. The buttocks must be cleansed 
and washed with a 1 : 1000 bichloride solution, and the 
rags used for this purpose had best be burned. 

The food may be disinfected by thorough cooking and 
the milk by boiling or pasteurization, which consists in 
heating the milk to a temperature of 70 degrees C. for 
half an hour and then chilling it suddenly. After the 
food and milk have been disinfected it is important to 
guard against their recontamination, by contact with in- 
fected water or by flies. 

The spoons, cups, and other tableware should be 
scaJded before being used again, and the remnants of food 



DISINFECTION FOR COMMUNICABLE DISEASES — CONT. $3 

remaining from the patient's meal should be burned or 
boiled before being thrown out. 

The hands of the nurse and others who come in contact 
with the patient or his discharges must be very carefully 
disinfected by immersing them in one of the germicidal 
solutions (see page 262). This procedure is important 
from a general standpoint of preventing the spread of 
the disease, but is doubly important on the farm or dairy, 
where the same hands that nurse the sick or handle the 
dejecta afterward milk the cows. 

The sick-room should be carefully screened to prevent 
the annoyance as well as the danger of flies. Any insects 
found in the room should be caught and burned. 

In cases where the above precautions have been intel- 
ligently carried out there is no reason to fear the spread 
of the infection, and it is not necessary to practice a gen- 
eral disinfection with one of the gases. In fact, both 
formaldehyde gas and sulphurous acid gas are of little 
practical use in combating an infection that is taken into 
the body through the alimentary canal and not the re- 
spiratory system. In other words, it is more important 
to boil the drinking water, and to thoroughly cook the 
food, and to pasteurize the milk, and to protect against 
the infection carried by flies, than to attempt to destroy 
with one of the gases the typhoid bacilli that may contam- 
inate the surfaces of exposed objects. 

Bodies dying of this disease that are to be shipped 
should be prepared according to Eule No. 2 of the rules 
and regulations of the boards of health and baggagemen's 
association. 



94 DISINFECTION FOR COMMUNICABLE DISEASES — CONT. 

Leprosy. — Leprosy is a communicable disease, trans- 
mitted from the sick to the well with difficulty. It is a 
disease of great antiquity and at the present time is 
widely distributed through the world, especially in the 
warm climates. 

The disease is caused by the bacillus leprae, discovered 
by Hansen in 1879. So far as is known it does not have 
spores. 

The disease may be transmitted from the sick to the 
well by inoculation into the skin or mucous membranes, 
the material containing the bacillus. The organism is 
found in great numbers in the pus and secretions from the 
broken down nodules and ulcers of the disease and in 
all the lesions of leprosy. They may also be found in the 
blood. As the nodules and ulcers frequently appear upon 
the mucous membranes of the nasal cavity, the secretions 
from the nose may be infective. 

So far as known, the principles of disinfection for 
leprosy are precisely the same as for tuberculosis. 

If a body dies of this disease and it is to be shipped, 
it should be prepared according to Eule No. 2 of the rules 
and regulations of the boards of health and baggagemen's 
association. 

Pneumonia. — Pneumonia is one of the most widely 
spread of the communicable diseases. It sometimes occurs 
in severe epidemics and with great mortality. The cause 
of pneumonia is the diplococcus pneumoniae. This organ- 
ism does not produce spores. The infection of pneumonia 
is probably always taken into the system through the 
respiratory channels. 



DISINFECTION FOR COMMUNICABLE DISEASES — CONT. 95 

The infection is thrown off with the sputum, which 
during the course of the disease is laden with great num- 
bers of the live and virulent germs. The infection may 
be eliminated in other secretions and discharges, depend- 
ing upon the seat of the lesion. The infection is spread 
from mouth to mouth, directly or indirectly, in a great 
variety of ways, just as the infection of diphtheria and 
tuberculosis is spread. 

The diplococcus of pneumonia does not show a high 
grade of resistance to external influences and may readily 
be destroyed by the germicidal agents commonly em- 
ployed against non-spore bearing infections. The germ 
when embedded in a mass of sputum is more virulent. A 
moist temperature of 52 degrees C. continued ten minutes, 
is fatal to the germ. Boiling water or steam destroys the 
infection at once. Fumigation with formaldehyde or sul- 
phurous acid gas are efficient when employed in the 
strengths and the times stated for each of these gases. 
(See Chapter XV). Bichloride of mercury 1:000, carbolic 
acid 3 to 5 per cent., tricresol 1 per cent., formalin 3 to 5 
per cent., are useful liquid disinfectants. Solutions of 
bichloride of mercury are not to be used for the disinfec- 
tion of sputum, because it is precipitated by, and cannot 
penetrate the albuminous matter. 

In general the principles of disinfection are the same 
as for diphtheria and tuberculosis. 

When a body dies of this disease and is to be shipped, 
it should be prepared according to Rule No. 3. 

Influenza. — Influenza is a communicable disease oc- 
curring in wide spread epidemics. It is also called "La 
Grippe." It spreads with greater rapidity than any 



96 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

known infection, for in a few weeks a whole continent 
may be involved. 

The period of incubation is from one to four days. 

The cause of this disease is the bacillus influenzae. It 
does not have spores. 

The disease is contagious in the sense that it is com- 
municable by contact between the sick and the well. The 
bacillus is found in great numbers in the secretions from 
the mouth and the nose of those suffering from the dis- 
ease, and the infection is chiefly eliminated through these 
channels. The bacillus is not found in the blood. 

Formaldehyde and sulphurous acid gas are trust- 
worthy disinfectants, in the strengths and times stated 
for the employment of these gases. The chemical solu- 
tions in their ordinary strengths, as employed for the non- 
spore bearing infections, will kill the bacillus of influenza. 
The disinfection for influenza will be about the same as 
that recommended for diphtheria and tuberculosis, es- 
pecially as the infection is largely thrown off from the 
body in the expectorated matter. The handkerchiefs, 
towels, bedding and other fabrics, that have come in con- 
tact with the infection should be boiled, steamed or im- 
mersed in one of the germicidal solutions. The room in 
which the patient has been, should be well fumigated and 
disinfected. 

When a body dies of this disease and is to be shipped, 
it should be prepared according to Rule No. 3. 

Cholera. — Cholera is a communicable disease native to 
India, where it is always present, sometimes existing in 
widespread and very fatal epidemics. From time to time 
it is transported along the lines of travel and commerce 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 97 

to all parts of the world. Many severe epidemics have 
been caused in seaport towns by the introduction of a few 
cases on a vessel. Cholera is often called Asiatic cholera 
on account of its home in India, to distinguish it from 
cholera nostras, cholera morbus, and other forms of non- 
communicable affections with choleric symptoms. 

A typical case of cholera is characterized by violent 
purging, cramps, rice-water discharges, and rapid col- 
lapse. 

The period of incubation varies from a few hours to 
five days. 

The disease is due to the u comma bacillus " discovered 
by Koch in 1883-1884. This microorganisms is curved or 
spiral-shaped and is therefore now called the spirillum 
cholerae Asiaticae. It is actively motile, and grows very 
well on alkaline media containing the slightest trace of 
albuminous matter, at ordinary temperatures as well as 
at the temperature of the body. 

The spirillum of cholera does not have spores. 

In the body the infection is confined to the alimentary 
tract. The cholera spirillum is practically always intro- 
duced into the system in the drinking water or with the 
food. It may also be introduced into the mouth by means 
of the hands or other objects that have become soiled with 
the infection. Of all the diseases of man that occur in 
epidemic form cholera is the type of the water-borne in- 
fections. There can no longer be any doubt but that the 
great outbreaks of this disease in large communities are 
always due to the contamination of the drinking water. 
The spirillum of cholera grows well in milk, and will keep 
alive and virulent a long time in moist albuminous food- 



98 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

stuffs, so that articles of food may spread the infection as 
well as the water. Vegetables and fruits are apt to be- 
come infected with the polluted water or from other 
sources, and if eaten raw may cause the disease. The 
flies play a similar role in spreading the infection of 
cholera that they do in typhoid fever. 

After the cholera spirillum passes the acid juices of the 
stomach, it grows and multiplies in such enormous num- 
bers in the intestines that every drop of the mucous dis- 
charges from the intestines may contain myriads of the 
organisms. During the course of its growth and multipli- 
cation it produces a poison or toxin which gives rise to the 
diarrhea, vomiting, cramps and prostration which charac- 
terize the disease. The spirillum of cholera remains con- 
fined to the intestinal canal. It does not invade the blood, 
and is therefore only eliminated from the body in the mat- 
ters passed from the bowels, and sometimes in the vomit. 

The cholera spirillum is somewhat less resistant to ex- 
ternal influences than the typhoid bacillus, and the same 
agents used for the destruction of the typhoid bacillus may 
be used for the destruction of the infection of cholera. 

A moist heat of 65 degrees C. will kill the spirillum of 
cholera in five minutes. Boiling water or steam at 100 de- 
grees C. kills the infection almost instantly. Most author- 
ities agree that it dies quickly when dried, usually in from 
three to four hours. In a moist condition it retains its 
vitality for months, especially in the presence of or'ganic 
matter, but it soon loses its virulence. The sunlight is also 
quickly fatal. 

The organism may live a long time in water, as may 
well be imagined from the fact that the disease is water- 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 99 

borne. In fact, it has been shown that if placed in ster- 
ilized water this organism grows with great rapidity and 
can be found alive after months have passed. 

Formaldehyde and sulphurous acid gas kill the spir- 
illum in the strengths and times stated for the employ- 
ment of these gases. 

All the ordinary germicidal solutions used in the 
strengths given for the destruction of non-spore-bearing 
bacteria, are efficient disinfectants for the cholera spiril- 
lum. For example, bichloride of mercury 1 :1000, carbolic 
acid 3 to 5 per cent., tricresol 1 per cent., formalin 3 to 
5 per cent., etc. 

The disinfection of cholera begins at the bedside. In 
general, the measures and methods described to prevent 
the dissemination of the infection of typhoid fever are 
applicable to cholera, and need not be repeated in de- 
tail. 

Most important is the destruction of the infection in 
the stools and in the vomited matter. For this purpose 
use formalin 5 per cent., carbolic acid 5 per cent., tricresol 
2 per cent., or lime, and thoroughly incorporate the dis- 
infectant throughout the mass and allow it to remain cov- 
ered one hour. The above substances are considered the 
most trustworthy for the disinfection of these materials 
in small amounts, but in their absence other germicides 
mentioned in the article on excreta (page256) may be 
used. Bichloride of mercury is not applicable for this 
purpose, on account of its lack of penetration in the pres- 
ence of albuminous matter. 

All the bedding, body linen, towels, and other fabrics 
that have in any way come in contact with the patient or 



100 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 



his discharges should be immediately boiled, steamed or 
immersed in one of the disinfecting solutions. The hands 
of the nurse and the body of the patient must also be kept 
clean and free from infection by frequent use of one of 
the disinfectants applicable to this particular purpose. 

The excreta and all objects that have become contam- 
inated must be disinfected at once, or, if this is not possi- 
ble, they must be carefully protected from the flies and 
other insects. 

When cholera prevails or is present in the epidemic 
form, it is essential to boil all the drinking water and 
thoroughly cook all the food. More than this, it is im- 
portant not to eat or drink out of cups or plates that have 
been washed with the infected water. All the table 
ware must be scalded, and the milk boiled or pasteurized, 
and no green vegetables, such as salad, radishes, celery, 
and the like, partaken of unless first treated with tartaric 
acid and washed as prescribed on page 259. 

There is no need to practice disinfection with one of 
the gases after a case of cholera, where the above precau- 
tions have been carried out. If through ignorance or 
neglect the infection has contaminated the room and its 
contents, a general disinfection may be done with formal- 
dehyde gas or sulphurous acid gas, according to the 
methods described for applying these agents for non- 
spore bearing infections. 

So well do we know the habitat of the cholera spiril- 
lum in nature, as well as its channels of introduction into 
and discharge from the body, that we can supply our 
germicidal agents with great accuracy and with every as- 
surance of destroying the infection and limiting the 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 101 

spread of the disease ; in fact, our methods have reached 
such a satisfactory state, that it is possible to live in the 
midst of a raging cholera epidemic without contracting 
the disease. 

A body dying of this disease, and is to be shipped, 
should be treated according to Rule No. 2 of the rules and 
regulations adopted by the health boards and baggage- 
men's association. 

Plague. — Plague, also called bubonic plague, la peste, 
black death, and other names, is a communicable disease 
occurring in widespread and very fatal epidemics in man 
and some of the lower animals. Of all the epidemic dis- 
eases, plague has caused more deaths in a shorter time 
than any pestilence known to man. In the thirteenth 
century, about a quarter of the people living in Europe 
died of this affection in a few years. 

The period of incubation is from three to five days, 
rarely over seven. 

The cause of plague is a short rod, called bacillus 
pestis. It grows well if kept at the body temperature, 
37 degrees C. It was discovered by Yersin in 1894, in 
the epidemic which was then raging in Hongkong. The 
plague bacillus in its growth, produces a poison, plague 
toxin, which is absorbed by the system, causing the 
fever, prostration and nervous depression, which char- 
acterizes all forms of the disease. When the bacillus 
enters the body through a wound in the skin, it causes 
a local inflammation which quickly spreads through the 
lymphatic channels to the neighboring lymph glands. 
These become swollen and painful, and are known as 
buboes — hence the name of bubonic plague. When the 



102 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

infection is taken into the respiratory tract, the inflam- 
mation in the lungs resembles very closely that of lobar 
pneumonia. When the bacillus is taken with food or 
drink into the alimentary canal, it may cause a sore 
throat, tonsils, or inflammation of the intestines. 

The bacillus of plague may be eliminated from the 
body in any of the discharges — that is, in the expec- 
torated matter, the pus discharged from the buboes, 
discharges from blisters, abscesses or carbuncles asso- 
ciated with the disease, or in the alvine discharges. It 
will, therefore, be seen that practically all the dis- 
charges from the body must be disinfected in order to 
prevent the spread of the disease. 

Animals, such as rats, mice, cats, dogs, cattle and 
other domestic animals are susceptible to the disease. 
It is believed that the flea is responsible for carrying 
the infection from rat to man. Ants and flies which 
have fed on infected material may deposit virulent 
bacilli through their excretions, in food, in drinkables, 
especially the milk, on the floors, tables, etc., and on 
the body and clothing of persons. These insects do 
not inoculate the disease germ into the system when 
they bite, as it is more probable that the irritation 
caused by the bites induces the individual to scratch or 
rub the infection into the skin. 

The plague bacillus is not a frail organism. In the 
presence of moist or albuminous matter it may keep 
alive and virulent for a very long time. It, however, 
dies quickly when dried. Moisture favors its life. Sun- 
light kills the organism in a few hours, providing the 
temperature in the sun is above 30 degrees C. Boiling 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 103 

water or steam at a temperature of 100 degrees C. kills 
the organism at once. The usual germicidal solutions 
are all efficient against plague in the strength in which 
they are ordinarily used for the destruction of non-spore 
bearing infections; for example, bichloride of mercury 
1 :1000, carbolic acid 3 to 5 per cent., tricresol 1 per cent., 
formalin 3 to 5 per cent. 

The plague bacillus is destroyed by fumigation with 
sulphur and formaldehyde gas in the strength in which 
these disinfectants are used (see Chapter XV). Form- 
aldehyde gas has very little effect on the higher forms 
of life, and as plague is a disease which is very largely 
spread through the agency of fleas, flies, rats, and other 
rodents, it is essential to use a disinfectant that will de- 
stroy vermin of this character as well as the plague ba- 
cillus itself. Sulphurous acid gas, chlorine gas and 
hydrocyanic acid gas are agents of this class, and they 
should be reviewed (see Chapter XV). 

Disinfection at the bedside of a case of plague should 
be rigorously carried out as a daily routine. All spu- 
tum, dejecta, urine, blood, pus, serum of the blisters, 
pus from the buboes, contain the infective material and 
must be destroyed. 

Bodies dying of this disease should not be shipped 
from one state, territory, district or province to another. 



CHAPTER VIII. 

DISINFECTION FOR THE COMMUNICABLE 
DISEASES. 

THE VERY CONTAGIOUS DISEASES. 

Scarlet Fever. — Scarlet fever is a communicable dis- 
ease occurring in epidemics among children. The dis- 
ease is characterized by a sore throat, a diffuse eruption 
and desquamation of the epidermis. 

The pathogenic microbe of scarlet fever, according 
to Klein and Gordon, is the streptococcus scarlatinae or 
conglomeratus, which they have isolated from the blood 
and nasal and tonsilar discharges of persons suffering 
from the disease. These observers have grown the strep- 
tococcus in broth, gelatine, agar, milk, and blood serum, 
in several of which media it gives a characteristic cul- 
ture. 

The incubation period is from three to four days. 

The disease is communicated directly from the sick 
to the well, probably through the agency of the fine 
scaly eruptions which are diffused with the dust through- 
out the room. The infection clings with great per- 
sistence to clothing of all kinds, and to articles of fur- 
niture and other objects in the room. Bedding and 
clothing that have been put away for months and even 
for years may, unless thoroughly disinfected, convey the 
104 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 105 

infection. Physicians, nurses and the embalmer may 
carry the infection to persons at a distance. 

Epidemics of scarlet fever have also been traced to 
the milk, and there is little doubt but that this fluid 
may be responsible for the spread of the disease. 

As far as the disinfection of scarlet fever is con- 
cerned, we must be guided by experience, and as a rule 
the same principles are applied as for smallpox. 

A body dying of this disease that is to be shipped 
should be prepared according to Rule No. 2 of the rules 
and regulations of the boards of health and baggagemen's 
association. 

Smallpox. — Smallpox is a communicable disease, the 
cause of which is not known. The incubation period 
is from twelve to fourteen days. 

Smallpox has long been considered a contagious 
disease, because it is more readily conveyed by contact 
between the sick and the well than any other of the 
communicable diseases of man. We know that the specific 
virus is thrown off from the patient into the surrounding 
air, perhaps with the exhaled air, and certainly from the 
eruption, whether fluid or dried in the crusts. It is proba- 
ble, though not proven, that the virus is contained in the 
blood, but not in the excreta. 

It is believed that the virus enters the system through 
the respiratory tract. It is definitely known that inani- 
mate objects which have come in contact with the pa- 
tient or the infectious discharges may retain the infection 
alive and virulent, and communicate the disease to others 
even after the lapse of a very long time. For example, 
blankets, bedding and clothing which have been used by 



106 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

the patient, and afterward packed away without any dis- 
infection, have caused the disease in other persons who 
have unpacked or handled these articles months after- 
ward. 

Although the cause is not known, fortunately we do 
know the disinfectant agents and their strengths neces- 
sary to kill the infectious principle, whatever it may be. 
So certain has our knowledge become that only wilful 
negligence or ignorance will permit smallpox to become 
epidemic in a community. In short, isolation of the sick, 
vaccination and disinfection will certainly prevent the 
spread of the disease. 

The disinfection for smallpox must begin at the bed- 
side. It is important to keep the skin of the patient well 
anointed with an oil or salve, to prevent the scaly erup- 
tions and the dried secretions of the eruptions from float- 
ing in the air. The sputum may become contaminated, 
and should be disinfected. The urine and the feces, al- 
though not believed to contain the virus, may also become 
contaminated and should be disinfected by methods given 
for these substances. (See pages 256-267). The doctor in 
charge should see that the sick-room contains only the 
necessary articles, and all carpets, hangings, upholstered 
furniture and other objects not necessary for the care 
and comfort of the patient should be removed. The win- 
dows should be screened to prevent the ingress and egress 
of flies and other insects, for it is reasonable to suppose 
that flies which come in contact with the eruption may 
convey the infection smeared on their feet and their 
bodies, to persons in other rooms of the same house or 
other houses. It is well to keep a sheet wet with a solu- 



DISINFECTION FOR COMMUNICABLE DISEASES— CONf. 10? 

tion of bichloride of mercury hanging in the doorway 
leading from the sick chamber, and to restrict the com- 
munication with the sick-room as much as possible. 

Treatment by the Embalmer. — "Wash the body with 
a disinfecting solution, bichloride of mercury 1 :1000, 
or carbolic acid 5 per cent., or the formaldehyde embalm- 
ing fluid you are using. Wash out the mouth, nasal ori- 
fices, eyes, ears, and plug all the orifices of the body with 
cotton saturated with a disinfectant solution. Give a 
thorough arterial injection, injecting sufficient fluid so 
that the skin becomes firm. If the body is to be trans- 
ported, which can be done under the rules of certain 
states, the treatment should be the same as for all other 
contagious diseases, that is, the thorough washing of the 
body with a disinfecting solution, thorough arterial and 
cavity embalming, wrapping the body in a dry layer of 
cotton at least one inch thick, and wrap in a dry sheet, 
and comply with the rules of the state board of health. 

The disinfection of the room and its contents may 
best be accomplished by one of the gases, either formal- 
dehyde or sulphur. These gases, though, cannot be de- 
pended upon for more than a surface disinfection ; there- 
fore carpets, hangings, clothing, bedding, upholstered 
furniture and other objects needing deeper penetration 
to disinfect them, must be removed for other treatment 
appropriate for each object, as has been described else- 
where. The preparation of the room for the fumigation 
should be carefully arranged, as described in Chapter 
XXIV. 

It is well for the embalmer and the fumigator in these 
cases to protect themselves and prevent spreading the 



108 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

disease by wearing the regulation disinfection suit. After 
the work is completed, the suit can be placed in a canvas 
bag and afterward disinfected separately. 

The former rules of the State Board of Health pro- 
hibited the transportation of bodies of persons dead of 
smallpox. The amended rules as adopted November 21, 
1912, permit the transportation of bodies dead of small- 
pox provided: "The body shall be thoroughly embalmed 
with an approved disinfectant fluid, all orifices shall be 
closed with absorbent cotton, the body shall be washed 
with the disinfectant fluid and enveloped in a sheet sat- 
urated with the same and placed at once in the coffin or 
casket which shall be immediately closed, and the coffin 
or casket or the outside case containing same shall be 
metal or metal lined and hermetically and permanently 
sealed." Many states have adopted this ruling. 

Measles. — Measles is an epidemic communicable dis- 
ease. There is a fever, catarrhal symptoms, especially of 
the mucous membranes of the respiratory tract, and a 
rapidly spreading eruption with desquamation of the epi- 
dermis. 

The period of incubation is about ten days. 

The cause of measles is not known, but it is probable 
that the infectious agent is thrown off in the breath of 
the affected person. The disease is communicated by the 
secretions, particularly that of the nose, and there is no 
doubt but that the desquamating epidermis may also 
transmit the infection. So far as the methods and chan- 
nels of infection are concerned, this disease resembles 
smallpox. The infection may also be transmitted through 
a third person or by fromites — that is, inanimate things. 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 109 

The disinfection for measles is the same as for small- 
pox, and need not be repeated here. 
Points to remember. 

(1) That it is an acute contagious disease. 

(2) That it is highly contagious, and affects most 
children. 

(3 That it rarely occurs more than once in one's 
life-time. 

(4) That its infecting agent is not known, only that it 
is classed with the diseases caused by protozoa. 

(5) That males are more susceptible than females. 

(6) That the mortality is light, death mostly occur- 
ring from complications. 

(7) That the strictest sanitary measures should be car- 
ried out in the treatment of it. 

When a body dies of this disease and is to be shipped, 
it should be prepared according to Rule No. 3. 

Mumps, — Mumps, sometimes called epidemic parotidi- 
tis, is a communicable disease, often occurring in the 
epidemic form. It is an inflammation of the parotid 
gland. 

The cause of mumps is the tetrad of mumps. 

The period of incubation is from two to three weeks. 

How the disease is communicated from the sick to the 
well has not as yet been determined, but is supposed that 
the saliva contains the infective principle, and therefore 
handkerchiefs and other fabrics and objects which come 
in contact with the secretions of the mouth should be 
disinfected. 

"When a body dies of this disease, and is to be shipped, 
it should be prepared according to Rule No. 3. 



HO DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

Chicken-pox. — Chicken-pox is an acute communicable 
disease, frequently occurring in epidemics among chil- 
dren. The disease has no relation to smallpox. 

The cause of the disease is not known. 

The period of incubation is from ten to fifteen days. 

The disease is highly contagious in the same sense that 
smallpox is — that is, by contact between the sick and the 
well. 

As far as disinfection is concerned, precisely the same 
methods and agents recommended for smallpox are ap- 
plicable to this disease. 

When a body dies of this disease, and is to be shipped, 
it should be prepared according to Rule No. 3. 

Whooping-cough. — Whooping-cough is a communica- 
ble disease, sometimes epidemic, especially in young chil- 
dren. 

The cause of whooping-cough is not known. 

The period of incubation is from two to ten days. 

The disease is communicated directly from the sick 
to the well through the secretions of the mouth and the 
respiratory tract. The virus is also believed to be har- 
bored in handkerchiefs, towels, clothing, bedding, and 
upon furniture and objects in the room, and thus be able 
to transmit the disease. 

So little is known as to the cause of this disease and 
the method of its spread, that we have no accurate scien- 
tific data upon which to base our disinfection. 

All handkerchiefs, towels, eating utensils and other 
objects that come in contact with the secretions of the 
mouth, should be boiled or steamed. The room in which 



DISINFECTION FOR COMMUNICABLE DISEASES— CONT. m 

the patient is isolated should be well disinfected and 
fumigated. 

When a body dies of this disease, and is to be shipped, 
it should be prepared according to Eule No. 3. 

Typhus Fever. — This is a highly communicable dis- 
ease, formerly occurring in very severe epidemics. It now 
is a very rare disease because of sanitary measures. It is 
sometimes called spotted fever, jail fever, camp fever, 
hospital fever. It spreads in filthy, overcrowded and un- 
sanitary places. This disease in former years claimed 
many victims in Europe and in this country, but since 
modern improvements in sanitation have been introduced 
into cities and institutions, and the misery of poverty has 
been diminished, there seems to be no tendency for the 
disease to spread, although it is always present in some 
of the larger cities. 

Typhus fever is acute, specific, a febrile disease, char- 
acterized by sudden onset, severe depression, and a rash. 
The fever usually terminates by crisis about the end of 
the second week. 

The cause of the disease is unknown. The period of 
incubation is about twelve days. The disease is believed 
to be contagious in the sense that it is communicated by 
contact between the sick and the well. "When the disease 
exists in the epidemic form, it is the most highly con- 
tagious of all the diseases of man. The nurses, physicians, 
and those who come in contact with the patient are the 
first to take the disease. Once an epidemic, few escape. 
The infection seems to be given off into the atmosphere 
surrounding the patient, although at the present time 
nothing is known definitely as to the way the infection 



112 DISINFECTION FOR COMMUNICABLE DISEASES— CONT. 

may leave the body or the channels of infection. It is 
evident that sanitation is needed to prevent the disease, 
where it prevails, and consequently not much disinfection 
is required. 

When a body dies of this disease, and is to be shipped, 
it should be prepared according to Rule "No. 3, unless 
more stringent requirements are enacted. 



PART III. 



PROPHYLAXIS IN GENERAL AGAINST DISEASE. 

113 



CHAPTER. IX. 

VITAL PROCESSES. 

After having studied the causation of disease, the 
modes of dissemination and spread of special diseases, a 
still more important part remains — that of the prophy- 
laxis in general against disease. 

Prophylaxis means the prevention of disease, and it 
is found that disease to a certain extent can be prevented 
by vital processes and by some special processes. 

Immunity. — Immunity may be said to be that con- 
dition which exists in an animal that enables him to resist 
the entrance of disease-producing germs, or when the 
germs gain entrance to the body, their growth and devel- 
opment are prohibited. Or, immunity may be said to be 
that condition existing in the body which will keep one 
from taking a disease. 

Susceptibility is that condition directly opposite 
immunity. Instead of resisting the entrance ov growth 
of disease germs in the animal body, a passive inertia 
exists which permits the pathogenic bacteria to develop 
without opposition. Or, susceptibility is a certain condi- 
tion existing in the body that will render the person 
liable to take a certain disease. 

Immunity is only a relative term ; all living organisms, 
at least all the higher forms, are susceptible under certain 
conditions, to some kind of parasitic invasion. On the 

115 



115 VITAL PROCESSES 

other hand, some degree of resistance against parasitic 
attack seems to be manifested by all animals and plants. 
In some cases the defense is so effective that bacteria and 
other parasitic microorganisms rarely invade the body 
under natural conditions. The wild carnivora, for ex- 
ample, are probably exempt from bacterial infections. 
The cat and the dog, as is well known in bacteriological 
laboratories, show, as a rule, a high degree of resistance 
to inoculation with bacteria that are highly pathogenic 
for other animals. In other cases infection occurs more 
readily. Man is susceptible to infection with a great 
variety of microorganisms, certain of which possess little 
or no pathogenic power for any other animal. Resistance 
to bacterial infection is often naturally inborn of race or 
individual. Such resistance is termed natural immunity 
and is the converse of natural susceptibility. 

A state of natural susceptibility may be transformed 
by various causes into a condition of greater or less re- 
sistance, commonly designated as acquired immunity. 

Most civilized men are born with natural suscepti- 
bility to smallpox, but acquire immunity during their in- 
vidual lifetime by vaccination or by an attack of the 
disease. 

Immunity is divided into natural and acquired im- 
munity. 

Natural Immunity. — By this term is meant the natural 
and constant resistance which certain healthy animals 
exhibit toward bacterial infection. Natural immunity 
may be said to be a condition which is transmitted from 
parent to offspring. Natural immunity depends upon the 
simple fact that a microorganism which finds favorable 



Vital processes 117 

conditions for multiplication in one species of animal 
meets with unsuitable conditions in another species. 

The metabolic differences, such as those between warm- 
blooded and cold-blooded animals, are in themselves suffi- 
cient to account for much so-called natural immunity. 

Closely related races and species of animals sometimes 
display, one a natural immunity, another a natural sus- 
ceptibility to the same infecting agent. 

Members of the same family, exposed at the same time 
to the same possibility of infection, show greatly varying 
susceptibilities. 

Acquired Immunity. — Acquired immunity is a condi- 
tion which is brought about by accidental circumstances. 
It is an immunity established in one's own lifetime. Ac- 
quired immunity is divided into active and passive im- 
munity. 

(a) Active acquired immunity is a condition existing 
in' the body, the result of the body having actually gone 
through the disease in one form or another. Active ac- 
quired immunity depends upon a specific reaction on the 
part of the cells and tissues of the individual organism. 
Such immunity is gained at the expense and often at the 
risk of the one acquiring it. An example of active ac- 
quired immunity is smallpox. The immunity may be ob- 
tained either by an attack of the disease due to natural 
exposure, or by the now common method of vaccination 
with cow-pox virus. 

Active acquired immunity once established as the re- 
sult of natural exposure will last a lifetime, or as in the 
case of vaccination, the body actually suffers from the 
disease, but in a milder form, without the patient know- 



118 VITAL PROCESSES 

ing of it or causing him any inconvenience. Immunity 
from vaccination is established for a period of from seven 
to eight years. 

(b) Passive acquired immunity is a condition exist- 
ing in the body, the result of having received into that 
body antitoxic substances formed in the body of another. 
The body does not actually go through the disease, but 
only has antitoxic properties injected into it, and as a 
result passive immunity is established. Passive immunity 
may be quickly acquired, but it is also much less perma- 
nent than active immunity and tends to quickly disappear. 

An example of this type of immunity would be the 
preventive treatment for diphtheria, gonorrhea and te- 
tanus, where the administration of the different antitoxins 
bring about a passive immunity, 



CHAPTER X. 

SPECIAL PROCESSES. 

Disinfection. — Disease may also in a measure be pre- 
vented by disinfection, fumigation, sterilization, and by a 
strict observance of the laws of hygiene and sanitary 
science in general. 

The term disinfection, strictly speaking, signifies the 
destruction of infectious agents, including microorgan- 
isms and any material that may contain infection. In 
general use, however, disinfection is applied more partic- 
ularly to the destruction of living microorganisms, hence 
the terms disinfectant and germicide have become synony- 
mous by usage. Owing to misunderstanding the mean- 
ings of terms in this connection, it seems necessary to give 
some definitions in order to prevent the confusion that 
arises from their indiscriminate and inaccurate use. 

A disinfectant or germicide may be defined as a 
substance that kills bacteria and their spores. 

An antiseptic is a substance that is antagonistic to 
or prevents the growth of bacteria, without necessarily 
killing them. 

A deodorizer may be either a disinfectant or an anti- 
septic, or neither, but simply a substance having the 
power of destroying or masking odor, without regard 
to either destruction of the microorganisms that cause 
it or the arrest of their development. Deodorants 

119 



120 SPECIAL PROCESSES 

are divided into two classes, after the manner in which 
they destroy or mask the odor. A true deodorant 
is one that acts chemically with the cause of the odor, 
and thus forever puts a stop to the obnoxious gases 
originating from that source. An example of a true de- 
odorant would be formaldehyde, and to understand how 
formaldehyde acts as a true deodorant, we must under- 
stand the nature and cause of putrefaction. (See page 
35). Putrefaction is the result of living saprophytic 
microorganisms trying to satisfy their own nutrition, and 
as a result of this, produce waste products in the form 
of gases which are unpleasant to the smell. Now, inas- 
much as the obnoxious gases are the result of bacterial 
work, a deodorizer, to be a true one, must retard or kill 
these living bacteria. Formaldehyde, when injected into 
the human body in the proper quantities and strengths, 
acts in this way, and is therefore a true deodorant. 

A false deodorant is one that, having a more pleas- 
ant and characteristic odor of its own, merely covers 
up the obnoxious odors superficially by masking 
them. An example of a false deodorant would be any 
perfume. The perfume is either placed superficially on 
the body or sprayed about the body or room, and in this 
way the obnoxious odor is covered up. But a false de- 
odorant can in no way be permanent, for when its char- 
acteristic odor wears away the obnoxious odor will again 
prevail, since the cause of the odor was not actually de- 
stroyed. The sweet smelling flowers would also be an 
example of a false deodorant. But few if any of the 
trustworthy disinfectants possess the power of completely 
destroying bad odors. In order to destroy a bad odor 



SPECIAL PROCESSES 121 

it is best to use a sufficient amount of an antiseptic to 
prevent decomposition and putrefaction, hence if we pre- 
vent decomposition, we prevent the generation of gases 
which emit bad odors. 

Disinfection may be brought about in a great many 
ways. The name applied will depend upon the agent used. 
Fumigation is that form of disinfection where the 
agent used is a gas having disinfectant properties. 
Sterilization is that form of disinfection where the 
agent used is heat in some form or a liquid chemical^ 
having germicidal properties. 

An object is said to be sterile when it is deprived of 
the power of producing bacteria. 

It is essential in practical disinfection that we should 
maintain a tolerably fixed relation between the amount 
of the given disinfectant used and the amount of matter 
to be disinfected, in order that an excess of either may not 
exist, as, if we use an insufficient amount of a disinfectant 
we may only produce an antiseptic effect and not a com- 
plete disinfection. The list of substances possessing 
germicidal properties is large, but those worthy of con- 
fidence are few. 

In order to prevent the spread of an infection it is of 
the greatest importance that complete disinfection be car- 
ried out from the beginning, hence competent and intelli- 
gent nursing is of primary importance, and it is not too 
much to say that if we completely disinfect all material 
that becomes infected, and all excretions, from the first, 
we will render the general disinfection much less unsat- 
isfactory. 

It is probable that protracted exposure to air and light 



122 



SPECIAL PROCESSES 



will ultimately destroy most, if not all, pathogenic mi- 
crobes, although under favorable conditions the virus of 
tuberculosis and other transmissible diseases has been 
shown to retain its vitality for many years. It would 
seem also that mere diffusion in the atmosphere may ren- 
der the virus inert. Typhus attacks a very large propor- 
tion of those who come into close contact with typhus 
patients, but rarely spreads under other conditions, even 
if the isolation is imperfect. Smallpox, on the other hand, 
is believed to be carried by air currents for a long dis- 
tance under favorable conditions. Spores of pathogenic 
bacteria would doubtless be among the most resistant, but 
mechanical portability (influenced by the form of the 
microbe and the size and weight of the epithelial scales or 
3ther particles to which the microbe may be attached), 
the dryness (or the reverse) of the air, and the chemical 
effect of the atmospheric oxygen, are possible factors, and 
it is at all events conceivable that a certain minimum 
"dose" of virus is necessary for infection, so that mere 
dilution beyond a given point would render the virus 
harmless, even without destroying its vitality. 

According to Koch, mere drying kills cholera bacillus. 
The complete disappearance of measles and other in- 
fections diseases from a district, often long periods after 
a widespread epidemic, is in itself a sufficient proof that 
an enormous amount of contagion does in some way or 
another speedily become inert, apart from all attempts 
at disinfection and exhaustion of available susceptible 
material. 

Mechanical removal of infection from rooms or gar- 
ments is often an important adjunct to disinfection 



SPECIAL PROCESSES 123 

proper. "Walls are stripped of paper, or scraped, or 
rubbed with dough, or washed; floors are washed or 
swept ; a strong current of air is sent through the room ; 
garments are washed or brushed, or beaten, and hung 
out in the open air. As a rule, such measures, though 
effectual as far as they go, are in themselves incomplete 
safeguards, since some portion of the virus may escape 
dislodgment, and there is no certainty as to the future 
harmlessness of the rest. 

True disinfection, that is, the destruction of the germs, 
may be divided into four general classes, as follows : 

Physical disinfection, 

Mechanical disinfection, 

Thermal disinfection, 

Chemical disinfection. 



CHAPTER XI. 

SPECIAL PROCESSES.— Continued. 

Physical Disinfection. — Physical disinfection means the 
destruction of germ life by means of natural influences, 
such as sunlight, natural electricity, etc. 

Physical disinfection is valuable to us from any stand- 
point. From the standpoint of the embalmer it is an 
essential subject, since it deals with nature's way of 
securing pure surroundings for the living, and any subject 
pertaining to the purity of the air must needs be important 
to embalmers, who are sometimes compelled to work 
under the handicap of impure air. 

Described as a part of physical disinfection we find 
the disinfecting processes of nature. It may not have 
occurred to you previously that exposing a room to sun- 
light is one of the most powerful ways we have of proceed- 
ing against the life of pathogenic germs within that room. 

The discharge of lightning produces ozone, an allo- 
tropic form of oxygen characterized by the metallic odor 
in the air after a hard electrical storm. Ozone produced 
in this way is a very effective agent in the natural purifi- 
cation of the air. 

Germ life demands moisture for its very existence. Un- 
der these circumstances, any form of dryness is a natural 
impediment to the life of germs. 
124 



SPECIAL, PROCESSES— CONTINUED 125 

Understanding the natural forces against the life of 
germs, we can have a broader conception of the impor- 
tance of sanitation as a man-made power against disease. 

Light. — That light affects the metabolism of living 
cells is well known, and the various reactions to light that 
are exhibited by the higher organisms have been the sub- 
ject of much investigation. 

In connection with the study of bacteria the germicidal 
influence of light has received most attention. 

Diffused sunlight has been found to exercise a hinder- 
ing effect upon bacterial growth and matabolic activity. 

Direct sunlight is highly injurious to certain forms 
of bacterial life, many organisms being killed almost in- 
stantly when exposed to the full action of the sun's rays. 
Sunlight is an active germicide, and its destructive ac- 
tion is not only confined to bacteria, but also to spores. 
The importance of the sun's rays in preventing and de- 
stroying the development and growth of microorganisms 
in nature can not be over estimated. Unfortunately the 
sunshine is so uncertain and the force of the sun's rays so 
variable, and their disinfecting power so superficial, that 
it can not be depended upon as an aggressive measure in 
attacking infection in rooms and confined spaces. 

Sunshine comes more under the jurisdiction of the 
sanitarian than of the disinfector, but the latter can al- 
ways use it to advantage in supplementing his other meth- 
ods, and especially in out-of-the-way places. Rooms and 
objects may always be sunned and aired to advantage 
after disinfection. As an example of the germicidal pow- 
ers of sunlight, we will quote Pansini, who in 1890 pub- 
lished the results of his experiments to determine the 



126 SPECIAL PROCESSES— CONTINUED 

action of sunlight on the following microorganisms : 
bacillus anthracis, prodigiosis, pyocaneus, violaceus, mu- 
ricepticus chorela and staphylococcus albus. He found 
that even the diffused light had marked effect in restrain- 
ing the growth of these bacteria after it had acted twenty- 
four to forty-eight hours. Direct sunlight acting perpen- 
dicularly on the cultures, sterilizes them all within one 
day. When the sunlight acted obliquely it was necessary 
to expose the cultures several days to sterilize them com- 
pletely. 

That the unfavorable influence of sunlight is not due 
to the heat rays is shown by the use of a screen (alum 
solution) which intercepts the heat rays but allows the 
germicidal rays to pass through. The blue and the violet 
rays have the most marked germicidal power. 

The action of light on bacteria has been picturesquely 
shown by protecting certain portions of colonies of bac- 
teria in plate culture and allowing the rest of the plate 
to receive the full effect of the sun's rays. If properly 
handled, plate colonies of bacteria will develop in the 
shaded portions, but no colonies will appear in the ex- 
posed portions. 

The germs of plague and cholera die more quickly 
than those of tuberculosis. Spores are very much more 
resistant to the action of the sun's rays than the bacterial 
cells themselves. A good example is found in the time 
required to kill an anthrax spore and bacillus. It re- 
quires thirty hours to kill anthrax spores, while two hours 
may be sufficient to kill the bacteria. 

Just how the light kills bacteria is difficult to explain 
satisfactorily. That the action is chemical seems likely, 



SPECIAL PROCESSES— CONTINUED 127 

from the fact that the ultra-violet rays of the spectrum 
are endowed with this power. 

Natural Electricity. — The action of the discharge of 
electricity contained in the lightning's flash is one of the 
most potent disinfectants and deodorizers ever observed. 

You have perhaps gone out on the street shortly after 
a severe electrical storm, where the discharge of lightning 
has rent the clouds and atmosphere and have noted the 
peculiar metallic odor present, which resembles that of a 
pine forest, or the atmosphere of Colorado or some of the 
localities of a highly electrically charged atmosphere. 

The odor described is that of the natural disinfectant, 
germicide and deodorant called "ozone." 

Ozone is formed by the subjecting of the air to high 
electrical pressure. 

Natural Dessication. — Natural dessication only -at times 
acts as a disinfectant. It is given here to show how re- 
sistant some forms of germ life are to the natural pro- 
cesses of drying, and to show that strenuous efforts should 
be made to disinfect these resistant forms of bacterial life. 

Many of the higher forms of life display considerable 
resistance to drying. The small aquatic worms, known 
as rotifers, will revive after months and even years of 
prolonged dessication. 

Seeds of the higher plants, which are specially adapted 
for resistance to drying, rarely outlast ten to twenty 
years. 

Most of the vegetative forms of bacteria are rather 
quickly destroyed by ordinary drying, although there 
are great differences among the different forms. The 



128 SPECIAL PROCESSES— CONTINUED 

tubercle bacillus is one of the more resistant, and the 
cholera spirillum is one of the most sensitive to drying. 

Exposure to dessication for a few hours, or at most a 
few days, destroys the majority of pathogenic micro- 
organisms, so that infection through the air, except where 
floating bacteria are protected by their position within 
the epithelial scales or in droplets of moisture, is not so 
common as popularly supposed. 

The spores of bacteria are much more resistant to dry- 
ing than the vegetable forms. The spores of anthrax will 
germinate after remaining in the dry condition for at 
least from ten to twenty-five years. 

Atmospheric Pressure. — Pressures of 600 to 700 at- 
mospheres are said by some observers to have an inhib- 
itory effect upon the putrefactive processes, but on the 
other hand, others state that living microorganisms are 
not effected by exposure for twenty-four hours to a pres- 
sure at 600 atmospheres. Roger says a pressure of 2,000 
atmospheres lessens the virulence of the anthrax bacillus. 

The effect of pressure can not be said to have been 
fully determined. 



CHAPTER XII. 

SPECIAL PROCESSES.— Continued. 

Mechanical Disinfection. — Mechanical disinfection 
means the destruction of germ life by means of mechan- 
ical processes, such as electric currents, nitration, etc. 

Electric Currents.— The action of electricity on bac- 
terial life has been closely studied by experimenters, only 
to arrive at contradictory results. 

Some very great claims have been made for the effects 
of different currents, but the latest researches have shown 
these to have been founded on error. 

It has been proven that electrical currents have very 
little germicidal action in themselves, and that the appar- 
ent effects are due more to the heat generated by the cur- 
rent or to electrolytic action. 

Experiments made to determine the effect of the elec- 
tric current upon bacteria have been in too many cases 
conducted loosely and inferences have been drawn that 
have not been warranted by the conditions of the experi- 
ment. 

In some instances, when a small amount of water is 
used, a rise in temperature is produced which is sufficient 
to account for the death of bacteria. In other cases death 
is due to the action of strongly germicidal substances like 
chlorine and ozone, which are liberated by the passage 
of the electric current; 

129 



130 SPECIAL PROCESSES— CONTINUED 

When the effects due to heat and to the electrolytic 
production of germicides are eliminated, it is very doubt- 
ful whether any direct action can be properly attributed 
to the electric current. 

The Roentgen rays have not been definitely shown to 
exert any germicidal effect. The results obtained by 
surgeons must be possibly attributed to the " ozone' ' 
formed by the discharge of the current, or perhaps to the 
production of hypo-chlorous acid, organic hyper-oxides, 
etc. 

Electric Light. — The electric light exerts a germicidal 
influence similar to that of the sun's rays, but the action 
of a 900 candle power light is weaker than that of the 
sun's rays. 

The time required for light to arrest multiplication 
and for the destruction of germ life is far from being 
definitely fixed. There are many conditions besides the 
brightness of the light to consider when determining the 
germicidal power. Such conditions as moisture, tempera- 
ture, and transparency and thickness of the media, etc., 
aid or hinder the action of the rays, and the length of 
exposure for different microorganisms must also be con- 
sidered. 

Filtration. — Filtration has earned recognition as a 
mechanical form of disinfection. Used in water purifica- 
tion, it has reduced the possibility of infection from 
water-borne diseases to the smallest possible perecentage. 

The germ of typhoid fever is one of the water-borne 
germs against which filtration is directed. For small 
filters, porous artificial stone is used ; the water in passing 



SPECIAL PROCESSES— CONTINUED 131 

through the pores leaves the impurities in the stone. The 
stones are cleaned from time to time so as to secure the 
purest conditions and the best filtration. 

In large filtration projects, such as the filtration of 
the entire water supply of a city, the water is first con- 
ducted into settling basins, where the foreign impurities 
little and leave the clear water above. After this the 
water is conducted into filtration beds and passes through 
gravel, etc., until it finally emerges as pure as water can 
be made. Chemicals are frequently used to assist the 
purification. 

The efficiency of the filtration processes, especially in 
some of the larger cities, is entirely responsible for the 
constantly decreasing death rate from typhoid. 

A concrete example of simple filtration by means of 
natural influences is seen in the little stream which may 
have its origin in the barnyard. Here the water is green 
and putrid and teems with bacteria. The little stream 
now flows down through the meadow, over the pebbles, 
sand, through leaves, until it finds its way into the woods. 
Here we will stoop down to drink the cool, sparkling 
water, and it is pure and wholesome, and we do not get 
a disease. 

The water which was putrid in the barnyard is pure 
in the woods, and has been made so by nature's own 
process of filtration and the germicidal action of the 
sun's rays, also the nitrifying action of bacteria. 

Ozone. — As a mechanical disinfectant, it is used to some 
extent in water purification. The production of ozone 
requires large and expensive apparatus to electrify cur- 
rents of air. This causes first a splitting up of the 



132 SPECIAL PROCESSES— CONTINUED 

oxygen atoms from the nitrogen, and then a concentra- 
tion of oxygen atoms results in the production of ozone. 
Ozone contains three atoms of oxygen to every molecule. 
Oxygen in its free state contains only two atoms to every 
molecule. In air we have two atoms of nitrogen coupled 
with one atom of oxygen to every molecule. The com- 
position of air is expressed by the formula N2O. 

On account of the expense of producing ozone, it is 
used very little in actual practice excepting for the de- 
odorization of air in rooms, etc. 



CHAPTER XIII. 



SPECIAL PROCESSES.— Continued. 



Thermal Disinfection — Sterilization. — Heat, in one 

form or another, is one of the most trustworthy germi- 
cides that we possess. We rarely speak of thermal dis- 
infection as the term generally applied to this form of 
disinfection is called sterilization. 

Sterilization is that form of disinfection where the 
agent used is heat in some form. 

Thermal disinfection or sterilization is usually divided 
into dry and moist heat. Dry heat is much less effective 
as a germicide than moist heat. The difference doubtless 
depends upon the fact that chemical or physical changes 
that cause the coagulation of protein, or the death of the 
protoplasm, take place, like such reactions generally do, 
more readily in the presence of water. 

Dry heat is divided into flame and hot air, and moist 
heat is divided into boiling water, steam, and steam under 
pressure. 



Sterilization 



dry heat 



moist heat 



flame 
hot air 

boiling water 
steam 

steam under pressure 
133 



134 SPECIAL, PROCESSES— CONTINUED 

Heat, then, is employed according to circumstances as 
ordinary fire with free flames ; as dry hot air, the articles 
to be disinfected being protected in a properly constructed 
oven; as boiling water; as streaming or live steam; and, 
as steam under pressure. 

Flame, or Burning. — All infected material which has 
but little value should be burned as the best means of 
preventing the spread of the disease. Fire is a great 
purifier; burning, however, has a very limited range of 
usefulness in practical disinfection. The free flames are 
resorted to only when it is desirable to consume valueless 
articles completely, which would hardly pay for the trou- 
ble of disinfecting by usual processes, for example, old 
straw mattress, worn-out clothing, useless furniture or 
bedding, etc. Although there are times and circum- 
stances where it may seem necessary to burn an article 
-in order to destroy all vestiges of germ life, yet the ad- 
vances made in science of germ destruction has been so 
rapid that the disinfector should never consign anything 
to the flames against the wishes of the owners, for we now 
possess methods by which objects may be rendered safe 
as far as the conveying of disease is concerned. 

In the actual practice of his profession, however, the 
disinfector should treat rubbish and articles of no value 
with fire, which will be the safest, cheapest and best 
method of disposing of them from a sanitary point of 
view. This method is also the best in a locality where a 
pestilent disease prevails. 

Dry Heat. — The process of disinfection by dry heat in 
ovens constructed for the purpose was formerly much 



SPECIAL PROCESSES— CONTINUED 



135 



more in vogue than at the present time. It has been 
practically abandoned for the reasons that dry heat has 
but little penetration power as compared with steam ; that 
it requires a longer time for penetration and disinfection 




Fig. 7.— Hot air sterilizer (McFarland's Pathogenic Bacteria). 

than is necessary for steam; and that the high tempera- 
ture and the prolonged exposure are together detrimental 
to many articles that are disinfected by this process. 

In a dry atmosphere, a temperature ranging from 140 
to 180 degrees Centigrade must be employed to insure 



136 SPECIAL PROCESSES— CONTINUED 

sterilization if continued for one hour. All forms of germ 
life, even the most resistant spores will be killed at this 
temperature. 

It is easy to maintain this temperature in an apparatus 
of special construction known as the hot air or the dry 
wall sterilizer. This method is used by many surgeons and 
embalmers to sterilize their appliances, such as glass- 
ware, etc. 

Such an apparatus can be obtained at only a little ex- 
pense. Procure an ordinary gasoline oven and line it 
with asbestos, through the top, cut a hole into which you 
are to insert a cork, then cut a hole through the cork and 
insert a thermometer which will register as far as 300 to 
500 degrees Centigrade. Then place such articles as can 
be sterilized by this method without injury, as glassware, 
etc., in the oven, then place the oven over the fire, being 
careful to watch the thermometer, for fear the heat will 
increase too far and break the thermometer. 

A dry heat somewhat less than 140 degrees Centigrade 
is sufficient to destroy many pathogenic bacteria, especi- 
ally the non-spore bearing variety, which are the cause of 
most of the epidemic diseases to which mankind is liable. 

Dry heat or hot air it not so reliable a disinfectant as 
other forms of moist heat, especially as it lacks penetra- 
tion, and is injurious to fabrics. Most materials will bear 
a temperature of 110 degrees Centigrade, (about 230 de- 
grees Fahrenheit) without much injury, but when this 
temperature is exceeded signs of damage soon begin to 
show. Scorching begins sooner with woolen materials, 
such as flannels and blankets, than with linen and cotton 
materials. The oven drying of fabrics renders them very 



SPECIAL, PROCESSES— CONTINUED 137 

brittle, but the injury may be lessened by allowing them 
to remain in the air long enough for them to regain their 
natural degree of moisture before handling them. Hot 
air or dry heat fixes many stains so that they will not wash 
out. This is especially marked with albuminous materials 
coagulated by heat, and the method should not be used 
with objects stained with blood, sputum, excreta, or simi- 
lar substances. 

Hot air apparatus labors under a three-fold disadvan- 
tage as compared with steam. 

(a) The available temperature and duration of ex- 
posure are limited by the tendency to scorch the articles 
exposed. 

(b) The penetration of heat is so slow that it is prac- 
tically impossible thoroughly to disinfect objects of mod- 
erate thickness, such as pillows ; and lastly, 

(c) The germicidal effect of a given temperature is 
far less with hot air than with steam. 

The only advantage that can be claimed for hot air 
is that leather and bound books are not spoiled by it as 
they are by steam. 

Boiling Water. — The spore forms of bacteria are al- 
ways much more resistant to the action of heat than the 
vegetative forms, and some species of bacteria when in the 
spore stage can withstand the temperature of boiling 
water for upwards of sixteen hours. The vegetative forms 
of most bacteria on the other hand are killed at a temper- 
ature of 55 to 58 degrees Centigrade and the most resist- 
ant by a 30 minutes' exposure to boiling water. 

Boiling is such an every day process that it is often 
neglected in practical disinfection, despite the fact that 



138 SPECIAL PROCESSES— CONTINUED 

it is the readiest and the most effective method of destroy- 
ing infection. Boiling is particularly applicable for the 
disinfection of bedding, body linens, towels and other 
fabrics, eating utensils, etc. 

You can greatly increase the disinfecting power of 
boiling water by adding a small amount of bichloride of 
mercury, carbolic acid, 1 or 2 per cent, of soda, or any of 
the soluble germicidal agents. The addition of lye, borax, 
or strong alkaline soap will also increase the penetrating 
power of boiling water. 

In as much as spores are resistant, it is best to use 
them as a standard, and then if we can kill all spores, we 
are doubly sure that we have a complete disinfection. This 
can be brought about by the discontinuous method of dis- 
infection. Boil the clothing on three successive days for 
one hour each day. After the boiling of the first day many 
of the spore forms will germinate which will be killed by 
the boiling of the second day, between the second and 
the third day still more will germinate which may be 
killed by the boiling of the third day, so that we are at 
last sure that by the three successive boilings all the spore 
forms are killed. 

But in many cases this is not necessary, for we may 
know the germs we are trying to kill, and if they are non- 
spore bearing we may feel safe to simply boil the material 
containing them for 30 minutes at 100 degrees Centi- 
grade. 

Complete immersion in boiling water tightly covered 
for 30 minutes will remove from clothing, dishes, etc., all 
known forms of disease germs. 

The addition of 1 per cent, of C. P. carbonate cf coda 



SPECIAL PROCESSES— CONTINUED 13Q 

solution renders the process applicable for polished steel, 
cutting instruments, or tools. 

Steam. — Steam is a most valuable disinfectant. It is 
reliable, quick, and may be depended upon to penetrate 
deeply. In practice the problem of disinfection is almost 
always complicated by the fact that the virus is not ex- 
posed freely, but enclosed in garments, pillows, or even 
beds ; that is, in more or less bulky articles made of ma- 
terials that have been selected for use as being the worst 
conductors of heat. It is found that steam rapidly pene- 
trates into the interior of such objects. 

Another important consideration is the effect upon the 
color and texture of fabrics exposed to heat. Articles 
composed in part of fusible substances, such as glue or 
sealing wax, are of course, ruined by heat in any form. 
Steam is inadmissible for leather objects, since it shrivels 
them up and renders them worthless; hot \vater merely 
makes them temporarily dry and brittle. With these ex- 
ceptions, steam is less injurious than hot air in almost 
all respects. New woolen goods, such as blankets and 
flannels, lose some of their whiteness and fleeciness by 
either process, but not more than in one or two ordinary 
washings. Silk and cottton are not injured by steam. Dyes 
are but little effected by steam. For the disinfection of 
bedding and fabrics of all kinds, and a variety of other 
objects, steam is applicable, and does no particular harm. 

A simple way of producing free steam for the disin- 
fection of small objects, such as body or bed linen and 
other fabrics, may be accomplished in this way. Secure 
ft common wash boiler, place on kitchen stove, and put 
three or four inches of water therein. Then arrange broom 



140 SPECIAL PROCESSES— CONTINUED 

handles across the top to hold the articles to be disin- 
fected. The whole should be covered with a sheet or some 
other cover to retain the heat and steam. 

To kill all spores by this method, it is best to steam 
the articles one hour each day for three consecutive 
days. This is called the discontinuous method. 

For non-spore bearing disease germs it is sufficient to 
simply steam for one hour at 100 degrees C. 

The addition of some salt to the water will raise the 
boiling point and the steam will therefore be given off at 
a higher temperature than 100 degrees C. which will add 
to the effectiveness of the method. 

It is essential that any apparatus for disinfection by 
heat should have doors at opposite ends, opening into 
separate rooms provided with separate entrances. One 
of these rooms should be strictly reserved for infected and 
the other for disinfected goods, and no articles should on 
any account be allowed to enter the latter room except 
through the stove, the object being of course to guard 
against the danger of reinfection of the purified articles. 

Steam Under Pressure. — If steam under pressure be 
used as the autoclave, exposure for fifteen minutes to a 
temperature of 125 degrees Centigrade is sufficient to de- 
stroy all forms of known microbes and spore forms. 

Steam under pressure is a more powerful disinfectant 
than my other form of heat. At a pressure of fifteen 
pounds to the square inch, steam has a temperature of ap- 
proximately 120 degrees Centigrade and will sterilize in 
fifteen minutes. 

In laboratories and surgical clinics the Arnold steam 



SPECIAL PROCESSES— CONTINUED 141 

sterilizer or Koch steamer is generally used for the dis- 
infection of all dressings, etc. 

Remember that disinfection with steam depends upon 
the temperature of the steam and the length of time you 
expose the material to be disinfected, to the steam. If you 
use a low temperature you must expose your material 
longer. If you use a high temperature you need not ex- 
pose your material so long. 

How to Change a Fahrenheit Scale to a Centigrade 
Scale and Vice Versa. — In the discourse on the various 
effects of chemicals in regard to temperature relations, we 
speak of the different thermometers Centigrade and Fah- 
renheit. 

The Centigrade thermometer is the one generally used 
for scientific work and has these important markings : 

(a) — Freezing point is at degrees. 

(b) — Boiling point is at 100 degrees. 

,(c) — And between these two points the scale is di- 
vided into just 100 equal divisions. 

The Fahrenheit thermometer is the one generally used 
for the household and by physicians in taking tempera- 
tures of the body and has these important markings : 

(a) — Freezing point is at 32 degrees. 

(b) — Boiling point is at 212 degrees. 

(c) — And between these two points the scale is di- 
vided into just 180 equal divisions. 

(d) — That degrees is just 32 degrees below the freez- 
ing point. 

Thus you see that one division on the Centigrade scale 
is just 9/5 of one division on the Fahrenheit scale, or vice 



142 SPECIAL PROCESSES— CONTINUED 

versa, one division on the» Fahrenheit scale is just 5/9 of 
one division on the Centigrade scale. 

Also that freezing point on the Fahrenheit scale is just 
32 degrees above zero point on that scale. 

These points must be taken into consideration in chang- 
ing one scale into another. 

"We have then two rules to learn. 
(1) — To convert Fahrenheit to Centigrade. 
Eule — From the Fahrenheit temperature given sub- 
tract 32, multiply by 5, and divide by 9 : 

Problem: Convert 98.6 F. to Centigrade, 
98.6 minus 32 equals 66.6 multiplied by 5 equals 333, 
divided by 9, equals 37. degrees. 

98.6—32 = 66.6 X 5 = 333 ~ 9 = 37. 

or, 

Rule— C = 5/9 (F —32). 

C = 5/9 (98.6 — 32). 
C = 5/9 (66.6). 
C = 37. 
(2) — To convert Centigrade to Fahrenheit. 
Rule — Multiply the Centigrade scale by 9, and divide 
by 5, and add 32. 

Problem: Convert 37 C. to Fahrenheit. 
37 times 9 equals 333, divided by 5 equals 66.6, plus 32 
equals 98.6 degrees. 

37 X 9 = 333. ~ 5 = 66.6 + 32 = 98.6. 
or, 

Rule— F = 9/5 (C) + 32. 
F = 9/5 (37) + 32. 
F = 66.6 + 32. 
F = 98.6. 



CHAPTER XIV. 

SPECIAL PROCESSES.— Continued. 

Chemical Disinfection.— Chemical disinfection means 
the destruction of germ life by means of certain chemicals 
which have come into general usage because of their 
peculiar properties in this regard. A chemical to be of 
practical value must not only be strongly germicidal as 
shown by laboratory experiments, but must also meet the 
many exacting requirements of the general practice, and 
such chemical substances are few in number. 

Chemical disinfection has been shown by the accurate 
experiments of Koch and others to be a matter of consid- 
erable difficulty, and comparatively few of the so-called 
disinfectants in common use prove to be really germicidal 
under the conditions of actual practice. A convenient but 
severe test is to expose to the disinfectant, for a defi- 
nite period, threads which have been soaked in a culti- 
vation containing anthrax spores and then dried. After 
the disinfection, cultivation or inoculation experi- 
ments show whether the spores survive or not, control ex- 
periments being made at the same time. Among the very 
few substances which killed the spores within a day (and 
for practical disinfection this is far more than can often 
be allowed) were mercuric chloride (1 per cent.), car- 
bolic acid and potassium permanganate (5 per cent.), and 
chlorine and bromine water. A 4 per cent, solution of 

143 



144 SPECIAL PROCESSES— CONTINUED 

carbolic acid took three days, and 1 per cent, permanga- 
nate had no effect in two days. Among those which failed 
were 5 per cent, solutions of chloride of lime, zinc salts, 
copper sulphate, ferrous sulphate, boracic acid, and sul- 
phurous acid, and 5 per cent, carbolic oil. Several of 
these, however, are able to kill less resistant forms, such 
as sporeless anthrax bacilli; or, serving as antiseptics, 
to prevent multiplication. A substance, to be a satisfac- 
tory disinfectant, should possess five characteristics: 

(a)— It should be germicidal within a reasonable time 
limit. 

(b) — It should not possess chemical properties which 
unfit it for ordinary use. 

(c) — It should be soluble in water, or capable of giving 
rise to soluble products in contact with the material to 
be disinfected. 

(d) — It should not produce injurious effects on the 
human tissues. 

(e) — It should not be too costly in proportion to its 
germicidal value. The substances which fulfill all these 
requirements are not numerous. Many valuable experi- 
ments have been made respecting such chemical bodies, 
because the conditions necessary to valid and comparable 
results have been ignored. These conditions are chiefly 
three, namely, using disinfectants which give regular and 
consistent results, using standardized bacterial cultures as 
to age and source and working with the same organisms. 
Out of the confusion of contradictory findings it is possi- 
ble, however, to name a number of reliable disinfectants. 
The liquid reagents most in use are mercuric chloride 
(1 : 500), potassium permanganate (5 per cent.), formalin 



SPECIAL PROCESSES— CONTINUED 145 

(5 per cent, solution), carbolic acid (5 per cent.), zinc 
chloride (2.5 per cent.), cresol, lysol, creolin and many 
compounds of the aromatic series (e. g. Jeyes' fluid, which 
contains the higher phenols, and forms emulsions with 
water). 

A most important consideration in regard to the 
more potent reagents forming the first series, is their 
working strength. If, for example, it is proposed to 
disinfect a putrescent liquid by means of permanganate 
of potash, it is absolutely useless to add a little 5 per 
cent, solution of the salt. We must add either the solid 
permanganate or a highly concentrated solution, until the 
permanganate is present as such to the extent of 5 per 
cent, of the whole weight of liquid, this five per cent, being 
of course in addition to the amount required to oxidize 
the organic matter. These essential conditions are rarely 
if ever observed in practice, and disinfection by per- 
manganate consists really of deodorization with partial 
oxidation of organic matter. A similar consideration ap- 
plies to mercuric chloride, which, if added to liquids con- 
taining organic matter, forms a precipitate that carries 
down part of the mercury in an inert form, and if sul- 
phuretted hydrogen is present, the equally inert sulphide 
of mercury is thrown down. So, too, with carbolic acid, 
which must form not less than 5 per cent, of the whole 
weight of liquid — not merely of the stock solution — if it 
is to destroy anthrax spores. 

Mercuric chloride is one of the chief reagents that can 
be conveniently employed in solution under such condi- 
tions as to destroy the most resistant microbes. One part 
of mercuric chloride in 1,000 parts of water destroys an- 



146 SPECIAL PROCESSES— CONTINUED 

thrax spores, according to Koch, but other observers have 
found this strength inadequate. The great drawback to 
this reagent is its extremely poisonous nature, but it may 
be kept in poison bottles properly labeled, and the solu- 
tion may be artificially colored with indigo, and odorized 
with thymol, as further safeguards. The following pro- 
portions are suggested: 

Mercuric chloride ^ ounce 

Hydrochloric acid 1 ounce 

Aniline blue 5 grains 

Water 3 gallons 

This ought not to cost more than one penny per gallon 
and should not be further diluted. Non-metallic vessels 
(wooden or earthenware) should be used. Articles soaked 
in the mercurial solution should be steeped in water for 
some hours before washing. 

Many fluid disinfectants are now applied direct to in- 
fected surfaces by means of a sprayer, such as chloride of 
lime (1 lb. to ten gallons of water), carbolic acid 5 per 
cent., formalin (40 per cent, solution, 4 oz. to the gallon). 

Chemicals may be either solids, liquids, or gases, and 
because of this fact it has been thought best to divide 
chemical disinfectants into the following classes: 

Solid disinfectants. 

Liquid disinfectants. 

Gaseous disinfectants. 

Classification of Chemicals. — The following table has 
been arranged to give the undertaker and the embalmer 
some idea as to the chemicals used by the profession. An 
attempt has been made by the authors to classify these 



SPECIAL PROCESSES— CONTINUED 



147 



chemicals as gaseous, liquid, solid disinfectants, preserva- 
tives, antiseptics, insecticides, blood solvents, bleachers 
and deodorants, or their use in embalming fluids or hard- 
ening compounds. 



NAME OF 
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Aluminic chloride 








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Ammonium chloride 








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Ammonium muriate 








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Ammonium sulphate 








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Arsenate of soda 








X|X| 






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Arsenic 








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Arsenite of potassium 








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Arsenous acid 








X|XI 






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Ashes 








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Benzoic acid 








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Benzoin 








1 1 


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Bichloride of mercury 




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Bisulphide of carbon 








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Boracic acid 








X|X| 


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Borax 








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Boroglyceride 








1 1 


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Bromine 


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1 1 1 


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Calcium chloride 


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Camphor 


1 






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Carbolic acid | 


X 




IXI 


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148 



SPECIAL, PROCESSES — CONTINUED 



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Chlorides ("Piatt's") 








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Chromic acid 








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Copper sulphate 








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Creosote 








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Cresols 




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Hydrocyanic acid 


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Hypochlorites 




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Lead chloride . . . 








IX! 




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Lead nitrate 








IX! 




III! 


Lime 






X 


1 1 




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Magnesium sulphate 






1 1 1 




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Mercuric iodide 






1 IX! 1 


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Milk of lime 




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Nitrous acid 


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Osmic acid 




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SPECIAL PROCESSES— CONTINUED 



149 



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Ozone 


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Peroxides 










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Phenol | 










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Potassic arsenite 










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1 1 




Potassic bichromate 










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IXI 






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IXI 


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IXI 


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Zinc sulphate 1 








IXI 


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Zinc sulphocarbolate i | 




1 

1 


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II IXM 



CHAPTER XV. 
SPECIAL PROCESSES.— Continued. 

Gaseous Disinfectants. — A few of the gaseous disin- 
fectants worthy of mention are: formaldehyde, bromine, 
sulphurous acid gas, nitrous acid, hydrocyanic acid, chlor- 
ine oxygen and ozone. 

A gas is the ideal agent for the destruction of in- 
fection which may be brought about by pathogenic bac- 
teria. By reaching all portions of a room or a confined 
space, it lessens the risk of overlooking any surface upon 
which the infective agent may be lodged. 

There is practically only one gas that is suitable for 
general application, viz., formaldehyde. This substance 
comes nearer being the ideal disinfectant than any of the 
gases so far in use. Formaldehyde is not poisonous, does 
not injure fabrics, colors, metals, or objects of art or 
value. 

Sulphurous acid gas is too destructive to fabrics, 
colors, metals, for it to have a very general use. It is 
very poisonous to all forms of animal life, which makes 
it particularly valuable for the disinfection against in- 
sect borne diseases. It probably has no equal for the 
disinfection of the holds of ships, cellars, sewers and 
other rough structures infested with vermin. 

Chlorine gas is very poisonous and too destructive for 
it to have a very wide range of usefulness. 
ISO 



SPECIAL PROCESSES— CONTINUED 



151 



Hydrocyanic acid can not be used in the household 
at all with safety because of its inflammable and explosive 
nature, and in practice is limited to the destruction of 
infection and vermin on board ships, in warehouses, 
granaries, greenhouses, and other uninhabited places. 

None of the gaseous agents can be depended upon 
for more than a surface disinfection, as they lack the 
power of penetration. 

Formaldehyde Gas. — Formaldehyde gas is the most 
useful and one of the best disinfecting agents that we 
possess. Its superiority depends upon its high value as 
a germicide, its non-poisonous nature, and upon the fact 
that it is not destructive. 

The secret of successful disinfection with this sub- 
stance, is to obtain a large volume of the gas in a short 
length of time, and at the present writing the ideal for- 
maldehyde generator is an unsolved problem. When 
failures come with its use, it is usually a result of an 
imperfect knowledge of its properties, its limitations, and 
its methods of destruction, because it is a very complex 
and unstable gas. 

Formaldehyde exists in three well recognized forms, 
viz. : 



CH20 


CH2O 

CH2O 


CILO 
CH2O 
CILO 


Formaldehyde 
gas 


Formaldehyde 
paraform 


Trioxymethylene 



152 SPECIAL PROCESSES— CONTINUED 

(1) Formaldehyde is a gas at ordinary temperatures, 
colorless, and possessing slight odor, but having an ex- 
tremely irritating effect upon the mucous surfaces of the 
nose and conjunctiva. At a temperature of about — 20 de- 
grees C. the gas changes into what is known commer- 
cially as paraform. 

(2) Paraform is a white substance, unctious to the 
touch, soluble in both water and alcohol. It consists 
chemically of two molecules of formaldehyde, and it is 
this substance which is supposed to compose the commer- 
cial solutions known as formalin. 

(3) Trioxymethylene is formed by the union of three 
molecules of formaldehyde. It is a white powder giving 
off the strong odor of the gas, and is but slightly solu- 
ble in alcohol and water. 

Formaldehyde gas possesses about the same specific 
gravity as air, which renders it poorly diffusible, although 
better than sulphurous gas and consequently it pene- 
trates more quickly to all portions of the room. 

As a germicide, it has the property of combining di- 
rectly with the albuminoids, forming the protoplasm of 
the microorganisms. It is perfectly plain, therefore, why 
there must be direct contact between the gas and the 
germ in order to accomplish disinfection. 

Because of its non-destructibility it is practically the 
only disinfecting agent which may be used in the rich- 
est apartments, containing objects of value, and art, 
without fear of injuring anything. 

Disinfection with this gas should never take place at 
a temperature less than 10 degrees C, as the gas con- 
denses at — 20 degrees C. to paraform, consequently in 



Special processes— continued 153 

cold weather the room to be disinfected should be heated 
by artificial means, up to about seventy-five degrees F. 

Moisture is necessary to obtain successful gaseous 
disinfection with this gas. Although the exact amount 
of moisture has not been determined, yet it is estimated 
that the full disinfecting power of formaldehyde gas is 
only obtained when the atmosphere is saturated to its 
maximum. It is therefore advisable in dry weather, to 
place a basin of boiling water in the room just before 
evolving the gas, and usually the apparatus on the market 
supplies means of producing watery vapor with the gas. 

Formaldehyde cannot be depended upon to accom- 
plish more than a surface disinfection, for under ordinary 
circumstances it possesses small powers of penetration. 
It takes a large volume and a long exposure to penetrate 
fabrics. The meshes tend to polymerize the gas and 
deposit it as a paraform upon the surface of the fabric. 
Large quantities of the gas are lost by uniting chemic- 
ally with the organic matter of the fabrics, especially 
woolens, which also hinders its penetration. 

Formaldehyde gas has the power of killing spores, 
although, not with sufficient certainty to render it a trust- 
worthy disinfectant for the infection due to spore bear- 
ing bacteria. 

Bacteria exposed directly to the concentrated action 
of the gas are destroyed almost instantly. Under similar 
conditions spores are sometimes killed within one hour. 
But in practical work it is necessary to prolong the time 
of exposure because the gas is evolved slowly from most 
of the forms of apparatus and it takes considerable time 
for it to penetrate all the corners and dead spaces of 



154 SPECIAL PROCESSES— CONTINUED 

a room. Bacteria and their spores are not always directly 
exposed upon the surface of objects, as they are in the 
laboratory experiments, and furthermore, they are fre- 
quently embedded in albuminous matter in the dust, 
which retards the penetration of the gas, and requires 
longer exposure. The length of time found necessary to 
kill infection will be given under the several methods 
for its use. 

Formaldehyde gas is not toxic to the higher forms of 
animal life, although it stands at the head of the list of 
germicides. Long exposures to weak atmospheres of the 
gas, sufficient to kill germs, have but the slightest effect 
upon the mammalian animals. Guinea pigs, rats, mice, and 
rabbits, exposed to the most concentrated atmospheres 
obtained by any of the methods for evolving it, are not 
killed after half an hour's exposure. The only effect 
produced is a violent irritation of the mucous membranes 
of the respiratory tract, from which the animals may 
subsequently die. If microorganisms were exposed to 
the same concentration of the gas they would be killed 
instantly. 

Formaldehyde is not a good insecticide. In the strong- 
est volumes of the gas obtainable it seems practically to 
have no effect upon roaches, bed bugs, and the great 
majority of vermin of this class. It will kill mosquitoes 
in the strengths and the time prescribed for the bacte- 
rial disinfection, provided there is direct contact between 
the gas and the mosquito. (See insecticides, page 207.) 

Formaldehyde is neutralized by ammonia. 

Methods of Producing Formaldehyde Gas. — The fol- 
lowing methods are given for the generation of formal- 



SPECIAL PROCESSES— CONTINUED 



155 



dehyde gas, and their value as well as the advantages 
and disadvantages will be given in connection with each 
method. 

The Direct Method.— Pass methyl alcohol (CEkOH) 
over a highly heated surface, asbestos discs coated with 
finely divided platinum, and the partial oxidation that 
occurs gives rise to formaldehyde gas. 

CH.OH + = CILO + H2O 

On this principle a number of lamps have been de- 
vised that have been used to some extent, but considera- 




Fig. 8.— Formalin lamp (Rosenau). 

tions of economy, and of ease and efficiency of applica- 
tion have prevented a very general introduction of this 
type of generator. 

There are several disadvantages to the direct method : 

(a) — It is of prime importance that almost all the 

vapor of the wood alcohol be changed to formaldehyde 



156 Special processes— continue!!) 

gas. If much of the vapor of wood alcohol escapes into the 
air unaltered it is liable to take fire and result in serious 
consequences. In none of the generators so far devised 
is the amount of formaldehyde theoretically possible, ob- 
tained from the alcohol consumed. 

(b) — It is also important to prevent the heat from the 
incandescent platinum flashing back and setting fire to 
the reservoir of alcohol which is used to feed the appar- 
atus. 

(c) — The gas is generated very slowly. It takes about 
two hours to convert three pints of wood alcohol, which 
is the amount required to disinfect 2000 cu. ft. of air 
space. When the gas is evolved so slowly it takes a long 
time for it to penetrate into all the nooks and corners of 
the room. 

(d) — It therefore lacks the penetration power of the 
quicker processes. 

One of the special advantages would be that nascent 
formaldehyde is liberated, and it is a well known fact 
in chemistry that reagents exert their most powerful 
effect when in this state. 

Another advantage is that the manner of evolving the 
gas is free from the objection of some of the other pro- 
cesses in that there is less polymerization of the formal- 
dehyde gas to paraform. Hence when a room is aired 
after the completion of the process, the unpleasant and 
irritating effects of the gas do not cling so persistently 
as in some of the other methods. 

This method may be used for surface disinfection of 
rooms not over 2000 cu. ft. and of tight construction. 
Use not less than 25 ounces of the wood alcohol for each 



SPECIAL PROCESSES— CONTINUED 157 

1000 cu. ft of air space, and prolong the exposure not 
less than twelve hours, preferably twenty-four. 

At the completion of the process there should be a 
distinct odor of formaldehyde gas. 

The Paraform Method. — By heating, not igniting par- 
aform, formaldehyde gas is evolved. Paraform will burn 
with a low, blue flame, but the resulting product of com- 
bustion contains no formaldehyde gas. In using this 
method to disinfect, it is therefore essential to heat the 
paraform to the point required to evolve the gas, but 
below the point of ignition. 

The Schering lamp and formaldehyde generator con- 
sists simply of a metal pan in which the paraform is 
heated by an ordinary spirit lamp. The wicks must not 
project more than a twelfth of an inch, which is enough 
to give a flame that will heat the pan and its contents 
sufficiently to cause volatilization of the paraform with- 
out danger of combustion. Should the paraform ignite, 
no formaldehyde gas will be evolved and the object of 
disinfection will be defeated. 

This method of evolving the gas is useful for the 
surface disinfection of closets and small inclosures, con- 
taining less than 1000 cu. ft. The space must be of tight 
construction, and all cracks and crevices must be care- 
fully sealed. The exposure should not be less than 
twelve hours, and preferably twenty-four. 

Use 3 to 4 ounces of paraform for each 1000 cu. ft. of 
air space. 

The disadvantages of the method are that the gas is 
given off without moisture and tends to polymerize read- 
ily, especially on cold, dry days. The gas is also given 



158 SPECIAL PROCESSES— CONTINUED 

off slowly and with little force, so that it penetrates 
poorly to all nooks and corners of the room. 

An advantage is that the method is simple and com- 
paratively cheap. 

The Key-hole Method. — Formaldehyde gas may be 
evolved from watery solutions by simply distilling it in a 
retort under pressure. 

The method consists of an autoclave, which is a retort 
sufficiently strong to withstand the required pressure. The 
retort is usually made of copper, as the formaldehyde 
solution attacks the iron. There is a water gage and a 
pressure gage. The outlet tube ends in a small copper 
tube that may be introduced through the key-hole of the 
door. The retort is usually provided with a safety valve, 
to prevent accidents. Heat is applied to the bottom of 
the retort by means of a bunsen burner or any other 
means suitable. Too much reliance must not be placed 
upon the level of the water in the glass while using the 
apparatus under pressure, for in practice it is found to 
be untrustworthy. 

The solution used in this apparatus consists of forma- 
lin 40 per cent., with the addition of 20 per cent, calcium 
chloride, or some other neutral salt, such as borax or com- 
mon salt ; 10 per cent, of glycerine may also be added. The 
neutral salt is added in order to prevent the polymeriza- 
tion of the formaldehyde, raise the boiling point and 
facilitate the evolution of the gas. Use not less than 16 
ounces of the solution for each 1000 cu. ft. to be disin- 
fected. 

Practically all the gas is given off from this form of 
apparatus during the first part of the operation, It is 



SPECIAL PROCESSES— CONTINUED 



159 



therefore necessary to charge the retort separately for 
each room to be treated. 

Sometimes this form of apparatus squirts a hot liquid 
from the outlet tube, and provision must therefore be 




Fig. 9.— Autoclave for evolving formaldehyde under pressure 
(Rosenau). 



made that nothing stands in line of the entering tube. 
Danger from this source may be obviated by hanging a 
towel a short distance in front of the tube and another 
on the floor to catch the drip. 

The disadvantages of the method are that it requires 



160 SPECIAL PROCESSES— CONTINUED 

a rather heavy and somewhat cumbersome apparatus, and 
that it takes a skilled hand to operate it. 

The method is applicable to rooms of any dimension, 
it being only a question of the size of the generator. 

By this method one to five hours will be sufficient ex- 
posure to kill all non-spore-bearing organisms, providing 
the room has no articles of furniture or clothing in it. 
If such be the case, an exposure of twelve hours is neces- 
sary in order to insure penetration. 

Simple Heating of Formaldehyde. — This method may 
be described the same as the key-hole method, excepting 
that the formaldehyde is evolved from the watery solu- 
tion without pressure, and the apparatus is placed inside 
of the room instead of the tube running through the key- 
hole. 

When formalin is boiled, the formaldehyde contained in 
the solution has a tendency to deposit as a powder instead 
of being driven off as a gas. 

Upon first heating formalin the water is mainly evap- 
orated, and subsequently the formaldehyde is disengaged. 
More of the disinfecting gas is evolved toward the end of 
the boiling than at first. In general practice, this point 
has a practical bearing when using the retorts without 
pressure. It is necessary to place the required amount of 
solution in the apparatus and to use it all. It will not do 
to fill the retort and use part of the gas and vapor evolved 
at first for the disinfection of one room and continue 
with the residue to disinfect another room, for the first 
might not get its full share of the formaldehyde gas. 

The commercial solutions of formaldehyde are used in 
this apparatus. The addition of 1 per cent, of glycerine is 



SPECIAL PROCESSES— CONTINUED 161 

claimed to add to the efficiency when evolving in this way. 
The glycerine is added because it raises the boiling point 
and retards polymerization of formaldehyde in solution. 
It deposits as an imperceptible film upon the surfaces 
exposed. The film is supposed to favor the disinfecting 
power of the gas by holding it in direct contact with the 
bacteria. 

Not less than 16 ounces of formalin, 40% for each 
1,000 cubic feet of air space should be used, and an ex- 
posure of twenty-four hours is quite necessary for com- 
plete disinfection where fabrics are to be penetrated. 

It requires about twenty-five minutes to distil 16 
ounces of the solution from this apparatus. The gas es- 
capes in a moist state, and it is therefore not necessary 
to add moisture to the room separately as in other meth- 
ods. 

The gas and watery vapor escape from the retort with 
considerable force, which aids diffusion and penetration. 
The method is therefore efficient for general application 
in disinfection whenever formaldehyde is indicated, par- 
ticularly in rooms up to 5,000 cubic feet capacity. 

Simple heating of formaldehyde in almost any kind of 
a vessel will give good results if a liberal amount of for- 
malin is used. Use 16 ounces 40% formalin for 1,000 
cubic feet air space, and add 10% glycerine to increase 
the penetrating and lasting powers. 

The Sheet Method — Spraying. — Spraying Js a very 
useful way of applying formaldehyde gas as a disinfec- 
tant, especially as it may be carried out without special 
apparatus. It has, though, distinct limitations, and unless 



162 



SPECIAL PROCESSES— CONTINUED 



all the necessary conditions are carefully observed, spray- 
ing is a very untrustworthy method. 

The formalin may be sprayed upon sheets hung up 
in a confined space, or it may be sprayed directly upon 
the object to be disinfected. In the latter case the object 
gradually becomes bathed in an atmosphere of the gas 



Fig. 10.— The sheet method (Embalmer's Monthly). 



which is slowly evolved by the evaporation of the liquid, 
and it also receives the benefit of the direct contact with 
the germicidal fluid. 

From watery solutions at the ordinary temperature, 
formaldehyde gas is given off very slowly, and in very 
uncertain quantities. It also diffuses slowly into dead 
spaces by this method. It is not applicable to large in- 
closures, nor to rooms having many drawers, nooks, or 
spaces where the gas would have difficulty in penetrating. 
The amount of the gas evolved from a given quantity of 



SPECIAL PROCESSES— CONTINUED 1£3 

sprayed solution is very variable, depending upon many 
conditions such as temperature, pressure, purity of solu- 
tion, surface exposed and other less known factors. 

In cold weather the formalin is apt to polymerize, and 
the water will evaporate from the solution sprayed upon 
the surface, leaving most of the formaldehyde as a white 
powder or solid residue. Hence the method should never 
be used except in warm weather or in rooms artificially 
heated. Warmth not only facilitates the evaporation of 
the fluid, but aids the disinfecting power of the gas. 

The formalin should be sprayed in very small drops, 
which exposes a maximum surface for evaporation. Large 
splashes of the solution, applied by means of brushes, 
mops and the like, are less reliable. 

A very common way to disinfect a room of small 
capacity is to spray not less than 16 ounces of formalin 
(containing 40% formaldehyde) for each 1,000 cubic feet 
air space, upon sheets suspended on lines across the room. 
Used in this way, a sheet 5 by 7 feet will hold about 16 
ounces without dripping or the drops running together. 

The room must be tightly sealed and kept closed for 
twenty-four hours. The method is limited to rooms not 
exceeding 2,000 cubic feet air space, because the gas is 
evolved so slowly, and there is more loss than can be 
be replaced by the slow evaporation, and the gas will not 
penetrate into the corners of large rooms with sufficient 
volume to insure its disinfecting action. 

It requires some practice to apply the sprinkling 
method effectually. The gas is irritating, and it must be 
done quickly and at the same time carefully, so that the 
liquid remains on the sheets in small drops. 



164 SPECIAL PROCESSES— CONTINUED 

The sheets may be wrung out in the formaldehyde solu- 
tion and hung up in the room, but while this method is 
simpler it can not be recommended as being as trust- 
worthy as spraying. 

The Formalin-permanganate Method. — In this method 
a large, open vessel is secured, with a flaring top, usually 
galvanized iron. This is placed within another vessel, 



Fig. 11.— Bucket used in the formalin-permanganate method 
(Embalmer's Monthly). 

preferably a tub, and place in this outside vessel a few 
inches of water, so that during the process of the evolu- 
tion of the gas, should it boil over, the outside vessel will 
prevent the material from going on the floor and doing 
damage. Besides, the vessel in which the gas is evolved 
becomes very hot, and therefore the water in the outside 
vessel serves as a non-conductor of heat. 

Place in the inside vessel 6% ounces of potassium per- 
manganate, and pour over this 1 pint of 40% formaldehyde 
for 1.000 cubic feet of air space. This, after a few seconds, 
will begin to bubble and boil up with the evolution of the 
formaldehyde gas. 

Remember that the potassium permanganate must go 



SPECIAL PROCESSES— CONTINUED 165 

in first, and that the temperature of the room ought to be 
above 60 degrees F. 

The Formalin-quicklime Method. — In this method use 
an earthen vessel. Place in this vessel 2 or 3 pounds of 
quicklime. Pour over this 16 ounces of a 40% solution 
of formalin, together with 5 ounces of sulphuric acid, for 
1,000 cubic feet of air space. 

Sulphurous Acid Gas. — The custom of burning sulphur 
in infected rooms has the sanction of antiquity, and under 
certain conditions is reasonably effective. 

Sulphurous acid gas is the active agent, and it is only 
when this agent is produced, that the disinfection is re- 
liable. 

Sulphurous acid gas is only produced when sulphur 
is burned in the presence of abundant moisture. 

Simply burning sulphur gives a production of sulphur 
dioxide. Sulphur dioxide is not, a disinfectant agent and 
as such should never be used. 

Sulphur + heat = sulphur dioxide. 

s + = SO* 

To make this sulphur dioxide a disinfecting agent 
there must be an abundance of moisture. 

Sulphur dioxide -\- moisture = sulphurous acid gas. 
SO* + H«0 = H.SO. 

The burning of sulphur, then, in the presence of mois- 
ture, has been found an effectual method of gaseous dis- 
infection, and one upon which entire dependence can be 



166 SPECIAL PROCESSES— CONTINUED 

placed at all times in disinfection after diseases due to 
microorganisms not containing spores. 

After the room has been prepared, reliable and cheap 
disinfection may be secured by the following methods of 
the use of sulphur: 




Fig. 12.— The pot method of burning sulphur (Rosenau). 

(1) Burn 3 to 4 pounds of sulphur in a vessel, in the 
presence of abundant moisture, as in Fig. 12 for every 
1,000 cubic feet of air space. 

A room ten feet long, ten feet wide and ten feet high 
has 1,000 cubic feet of air space. For a large closet use 
one pound of sulphur. 

(2) Sulphur may be burned in shallow iron pots 
(Dutch ovens), containing not more than 30 pounds of 
sulphur for each pot. The sulphur pot should be ele- 
vated from the bottom of the compartment to be disin- 
fected, in order to obtain the maximum possible percent- 
age of combustion of the sulphur. The sulphur should 
be in a state of fine division, and ignition is best accom- 
plished by alcohol. This method is especially applicable 
to cargo vessels, railroad trains, etc. Special attention 
and precaution should be given so that the material to 
be disinfected does not catch fire. 



SPECIAL PROCESSES— CONTINUED 167 

(3) Water -jacketed sulphur candles may be used in- 
stead of crude sulphur, but care must be taken to use suf- 
ficient candles. The average candle on the market con- 
tains one pound of sulphur. Three or four of these will be 
necessary to disinfect a room of 1,000 cubic feet. Do not 
use a less number, no matter what directions may accom- 
pany the candle. Partly fill tin around candle with water 
and place candle in pan on table, not on the floor, and let 
at least one-half pint of water be evaporated with each 
candle. Evaporate more if practicable. 

There is one serious objection to the use of sulphur, 
and this must be fully understood The fumes of sulphur 
(sulphurous acid gas) have a destructive action on fabrics 
of wool, silk, cotton and linen, on tapestries and draperies, 
and exercise an injurious action on brass, copper, steel 
and gilt work. Colored fabrics are frequently changed in 
appearance and the strength impaired. Colored fabrics 
which have been in a room during disinfection should be 
immediately exposed to the sun and wind. Uncolored 
fabrics which will not be injured by moisture should be 
at once soaked in water. This will prevent the further 
injury from the action of the sulphurous acid gas. 

Another disadvantage is that sulphurous acid gas lacks 
penetrating power, and besides, there is always a danger 
of setting fire to the floor and furniture unless proper 
precautions are observed. 

The use of sulphur as a disinfectant has the advantage 
in that it will kill not only bacteria but insect life, such 
as flies, mosquitoes, etc. 

(a) The infected rooms should be thoroughly closed, 
every crack and crevice sealed. 



168 SPECIAL PROCESSES— CONTINUED 

(b) Sufficient sulphur must be used. 

(c) There must be moisture in the room. 

(d) The time of exposure should be not less than six 
hours for the minimum. 

Chlorine Gas. — There are several ways of making 
chlorine gas, as follows: 

(a) By the use of chlorinated litne, commonly called, 
bleaching powder. By taking 3 to 4 pounds of this powder 
and adding one-half pint of hydrochloric acid, a free 
liberation of chlorine gas is obtained for 1,000 cubic feet. 

CaOCls + 2HC1 = CaCb + H.0 + 3C1 

This gas must be generated in an earthen dish. 
(b) By the use of peroxide of manganese. To gen- 
erate, take 4 ounces of peroxide of manganese (to be ob- 
tained at any drug store) and add 1 pound of hydrochloric 
acid for each 1,000 cubic feet of air space. The reagents 
must be placed in an earthen dish for generation of the 
gas. 

(c) By the use of sulphuric acid. In practice, the 
most convenient method of generating the gas is by de- 
composing iy 2 pounds of chloride of lime with 6 ounces 
of strong sulphuric acid. This produces a sufficient gas 
for the disinfection of 1,000 cubic feet of air space. 

(d) The gas may also be generated from — 

Common salt 8 ounces. 

Manganese dioxide 2 " 

Sulphuric acid 2 ' c 

Water 2 " 



SPECIAL PROCESSES— CONTINUED !($ 

Chlorine is a germicide of considerable but uncertain 
power. It has little practical usefulness, owing to its 
poisonous and destructive action. Both in its free state 
and in its watery solution it has very powerful deodoriz- 
ing properties. In the free state, moisture is necessary 
for its action. At best the gas is but a surface disinfec- 
tant. 

Chlorine is an extremely irritating gas, and great care 
must be observed in its employment, for the inhalation 
of very weak proportions of the gas produces serious irri- 
tation, resulting in spasm of the larynx, bronchitis, and 
even in death. Chlorine is heavier than air, and tends 
to fall, therefore the vessel generating the gas should be 
placed in an elevated position in order to obtain anything 
like an effective diffusion. Carpets, curtains and fabrics 
generally are injured by its action, and the element is a 
very active bleaching agent for all the organic colors. 

The germicidal action depends upon its great affinity 
for hydrogen. So strong is this affinity that it combines 
with the hydrogen of water in the presence of light, liber- 
ating the oxygen in a free state, thereby enabling it to 
exert its power against organic matter. 

Oxygen. — The disinfecting power of oxygen depends 
upon the physical state in which it exists. For instance, 
the oxygen in the air has feeble, if any, germicidal prop- 
erties, while nascent oxygen and ozone are powerful 
germicides. 

The germicidal action of oxygen depends upon its 
very active property of combining chemically with the 
albuminous master of the cell protoplasm. The oxidizing 
properties of this element, acting upon organic matter 



170 SPECIAL PROCESSES— CONTINUED 

and converting a great part of it into carbon dioxide and 
water, explains the purifying power of fresh air. 

Most bacteria, to grow and multiply, require the pres- 
ence of oxygen. In this case they are called aerobic. 
There is a large class of organisms that will not develop 
in the presence of even minute traces of oxygen. In this 
case they are called anaerobic bacteria. In fact, the oxy- 
gen of the air acts as a poison or strong antiseptic for this 
class of vegetable life, among which are tetanus, anthrax, 
malignant edema germs, etc. On the other hand, oxygen 
has no appreciable effect upon the spores of these bac- 
teria. 

Ozone. — Ozone is the allotropic form of oxygen, con- 
taining three atoms of that element to the molecule in- 
stead of two. In sufficient concentration it is a powerful 
germicide, although there is not sufficient ozone in the 
air normally to exert any appreciable disinfecting prop- 
erties. 

Ozone is produced as a result of a discharge of elec- 
tricity in the oxygen of the air. 

In a mechanical way it is produced by passing an 
electric arc through the air. It has a peculiar metallic 
odor, familiar about electric dynamos. In this way it 
is not a fumigating agent, but is used more for the puri- 
fication of the air in rooms or in public meeting-places. 

Hydrocyanic Acid. — Hydrocyanic acid is used exten- 
sively in the disinfection of nursery stock and greenhouses, 
as well as in flouring mills, against weevils; in railroad 
coaches against bedbugs, and in tobacco warehouses 
against insects in general. 

This gas is a fatal poison for all the forms of animal 



SPECIAL PROCESSES— CONTINUED 171 

life. It is much less destructive to vegetable life. It is 
a very powerful insecticide, but a weak germicide. Like 
the other gaseous disinfectants, it seems to possess no 
marked powers of penetration. 

The extremely poisonous nature of hydrocyanic acid 
gas makes it necessary to exercise very great care in its 
employment. It should never be employed about the 
household. In practical disinfection it may be used in 
the treatment of stables, granaries, outhouses, the holds 
of ships and similar uninhabited places, for the destruc- 
tion of insects. 

The gas is lighter than air and has an agreeable, aro- 
matic odor. It is best generated by the action of dilute 
sulphuric acid upon potassium cyanide in the following 
proportions. 

Potassium cyanide, 1.0 
Sulphuric acid 1.5 

Water 2.25 

The first step is to dilute the acid, which is best done 
by adding the acid to the water in a vessel capable of 
withstanding heat. The whole amount of the cyanide 
must be put into the acid at once, and as the evolution 
of gas is very rapid the operator must be ready to leave 
the spot immediately. 

This gas has few advantages over sulphur dioxide in 
ridding a place of vermin, and its germicidal value is 
inferior to formaldehyde ; and, as its poisonous nature is 
such a serious drawback, it has a very limited place in 
practical disinfection. 



CHAPTER XVI. 
SPECIAL PROCESSES.— Continued. 

Liquid Disinfection. — Liquid disinfectants are hard to 
apply to all the surfaces of an ordinary living room, and 
it is furthermore difficult to hold the solution in contact 
with the ceiling, walls, and other surfaces a sufficient 
length of time in order to obtain the certain action of the 
substance. 

Formalin. — Formalin is a very valuable liquid disinfect- 
ant and has a wide range of usefulness in general practice. 
The liquid is superior to bichloride of mercury for many 
purposes, for its action is not retarded by the presence of 
albuminous matter. Formalin does not injure most ar- 
ticles. It is a true deodorant also. 

Formalin consists of 40% of the gas formaldehyde in 
water. The liquid is a clear solution, giving off an odor 
of formaldehyde gas. 

Formalin solutions are rather unstable. There is a 
constant loss by evaporation if the liquid is not kept in 
well stoppered bottles. 

Hot formalin attacks iron and steel, and therefore can 
not be used for the disinfection of such objects. It does 
not attack copper, brass, nickel, zinc and other metallic 
substances. 

It causes no diminution in the strength of textile fab- 
rics, and has no bleaching or other deleterious effects 
172 



SPECIAL PROCESSES— CONTINUED 173 

upon colors. Formalin solution renders leather, furs and 
skins brittle as a result of the union that takes place 
between the formaldehyde and the organic matter of 
these articles, and they should therefore be disinfected 
by another method. 

The formalin as found upon the market is acid as a 
rule, due probably to formic acid. For this reason the 
solution is apt to spot the delicate colors of silks and 
fine stuffs. Even water will do this. Such articles should 
be disinfected with formaldehyde gas. 

A 4 % solution of formalin (containing 40% formal- 
dehyde) in water, is also the equivalent of a 1:1,000 
solution of bichloride of mercury, or superior to a 5% 
solution of carbolic acid. 

Feces are deodorized instantly by a 4% solution of 
formalin and are rendered sterile at the end of ten min- 
utes when mixed with an equal volume of a solution of 
this strength. 

Formalin is very useful for the disinfection of urine, 
excreta, sputum, and other albuminous matters. It com- 
bines with, but does not coagulate the albuminous matter 
and penetrates deeply. 

There is a great difference between the antiseptic and 
the germicidal value of formalin. That is to say, a very 
minute amount, 1 in 25,000 or 50,000, is sufficient to in- 
hibit the growth and development of bacteria, whereas 
it requires a 1 to 4 per cent, solution to kill bacteria in a 
short time. A very minute trace added to milk or wine 
and other fluids will preserve them for a long time from 
spoiling. Formalin added to milk makes it indigestible, 
and its use should not be allowed. 



174 SPECIAL PROCESSES— CONTINUED 

How to Make Solutions. — Rule: Subtract from the 
index (40) the per cent, desired; and divide the remain- 
der by the per cent, desired. 

The index of a solution is the percentage of purity, 
and in the case of formalin it has been established as 40. 
Formalin consists of 40 parts formaldehyde gas and 60 
parts water. 

Example : Make a 10% solution of formalin : 

40 minus 10 equals 30; and divided by 10 equals 3. 

The answer equals the parts of water to one part of 
formalin. 

Therefore, by adding 3 parts of water to one part of 
formalin of 40% strength you will get a ten per cent, solu- 
tion. 

Rule : Multiply the total solution (reduced to ounces) 
by the per cent, desired, and divide the product by the 
index. The answer is the ounces of formalin. The\ 
total solution, minus the ounces of formalin, equals the 
ounces of water. 

Example: Make a gallon of a 10% solution. 

1 pint equals 16 ounces. 
1 quart equals 32 ounces. 
1 gallon equals 128 ounces. 

The total solution, or one gallon, reduced to ounces 
is 128. 

128 times 10 is 1280 ; and, divided by 40, is 32, or the 
ounces of formalin. 

The total solution, 128, minus the ounces of formalde- 
hyde, or 32, equals 96, or the ounces of water. 

Often it may be the case that the formaldehyde you 



SPECIAL PROCESSES— CONTINUED 175 

may buy would be of a lesser strength, than is given 
before. That is to say, you may buy formaldehyde that 
is only 25% strength instead of the standard strength, 
which is 40%. 

In this case you will observe the same rules as are here- 
tofore provided, with the exception that the index will 
be made the same as the strength you have bought. 

For example : Make 10% solution from formaldehyde 
that is only rated at 25% : 

25 minus 10 equals 15; and, divided by 10 equals 1.5 
or l 1 /^ parts of water to 1 part of this grade of formalin. 

Or, according to the other rule : For 1 gallon of 10% 
formaldehyde from a grade of formaldehyde that is only 
25% index, 128 times 10 is 1280; and, divided by 25 is 
51.2, or the ounces of this grade of formalin. The total 
solution, 128, minus the ounces of formalin, or 51.2 equals 
76.8, or the ounces of water. 

Bichloride of Mercury. — Bichloride of mercury, or 
mercuric chloride, known commonly as corrosive sub- 
limate, is one of the most powerful and valuable liquid 
germicides known. In its action, it destroys all forms 
of germ life in very weak solutions. 

The germicidal power of bichloride has been care- 
fully studied in many laboratories, so that we are in pos- 
session of definite knowledge as to the exact strength 
and time necessary to accomplish the disinfection. 

A 1 :300,000 solution acts as an antiseptic for all forms 
of germ life. 

A 1 : 1,000 solution acts as a germicide and is ample 
for the destruction of all forms of germ life, at the ordi- 



176 SPECIAL PROCESSES— CONTINUED 

nary temperatures, provided that the exposure is contin- 
ued not less than one-half hour. 

Bichloride is particularly serviceable in a standard 
solution (1:1,000) for the disinfection of hands and 
body, not only of the dead body, but the live body as well, 
and for the disinfection of floors, woodwork, etc. 

Its disadvantages are as follows: 

(1) It can not be used as a deodorant. 

(2) It will corode all metals. 

(3) It forms insoluble compounds when brought in 
contact with albuminous matter; for this reason it is not 
applicable for the disinfection of feces or sputum, nor can 
it be used in embalming fluid. 

(4) It is a very poisonous compound, and therefore 
the solution should be colored or marked POISON, to 
prevent accident. 

(5) It is not adapted to aerial disinfection, for it will 
not produce gas in any form. 

How to Make Solutions. — A salt, when intended for 
liquid solutions, is based on the number of grains of salt 
to 1 quart of water ; accurately, 1 qt. water = 14579.2 
grains, but in use we say 1 qt. = 14000 grains. 

Rule : The total amount of water is to the total 
amount of corrosive sublimate as 1 part of water is to 1 
part of corrosive sublimate, or, 

Total amt. water: total cor. sub. ::% water ;% cor. sub. 

or, 
14579.2 : X : : 1000 : 1 
1000X = 14579.2 

X = 14.6 grains 



SPECIAL PROCESSES— CONTINUED 177 

Or again, if we want a quart of a 1 : 1000 solution, 
reduce the total solution (1 qt.) to grains, which would 
be 14579.2 gr., and divide this by the per cent, desired or 
1000, or 14579.2 gr. divided by 1000 equals 14.6 gr. 

Therefore if you add 14.6 gr. to one quart of water, 
you would get a 1:1,000 solution. 

Or again, if you want a quart of a 1:2000 solution: 
Divide the number of grains in one quart by 2000; or, 
14579.2 divided by 2000 equals 7.3 gr. 

Or again, if you want a gallon of a 1 :2000 solution, 
divide the number of grains in one gallon (4 qts.) by 
2000; or, 58316.8 divided by 2000 equals 29.2 grains. 

Carbolic Acid. — Carbolic acid is a very good disin- 
fectant and has a very wide range of usefulness. It can 
not be depended upon to kill spores, for it is not as 
strong a coagulator as bichloride of mercury. It may be 
used for the disinfection of bedding and also for excreta 
sputum and like substances. It is not as trustworthy as 
some of its by-products for these purposes, such as 
tricresol and lysol. 

Carbolic acid is known as phenic acid, phenyl alcohol 
and coal tar creosote, and is represented by the chemical 
formula Ce He O. It is produced by the dry distillation 
of coal and is the chief constituent of the acid portion of 
coal tar oil. Pure phenol crystalizes in long, colorless 
needles. The carbolic acid of commerce forms a crystal- 
ine mass which usually turns red in time and in contact 
with moist atmosphere liquidizes into a brown liquid. 
Carbolic acid has a penetrating odor, a strong, burning 
taste, and is a corrosive poison. 

The carbolic acid of commerce contains impurities, 



178 SPECIAL PROCESSES — CONTINUED 

such as the cresols and the higher by-products, some of 
which have a higher germicidal power than the pure car- 
bolic acid itself. The commercial product also contains 
tar oils which are probably lacking in germicidal quali- 
ties. The cruder chemical containing these impurities has 
been shown to be superior to the highest grades of refined 
acid, which is practically pure phenol. 

The acid dissolves in about 15 parts of cold water at 
the ordinary temperature. In this proportion the satu- 
rated solution contains between 6 and 7 per cent, of the 
acid. It is commonly used in 3 to 5 per cent, solutions, 
which are entirely trustworthy for the disinfection and 
destruction of all infectious diseases due to non-spore- 
bearing microorganisms. 

The acid in 5 per cent, solution is not destructive to 
fabrics, colors, metals or wood, and may therefore be em- 
ployed for the disinfection of a great variety of objects. 

The fact already mentioned, that it does not readily 
coagulate albuminous substances, renders it particularly 
applicable to the disinfection of excreta, sputum, urine 
and the like. Carbolic acid should not be used for the 
disinfection of tetanus, anthrax, and other diseases due 
to spore-bearing bacteria. 

A 5 per cent, solution of carbolic acid is very useful as 
a general disinfecting agent, and is especially applicable 
for sputum and other discharges from the nose and mouth 
occurring during the process of embalming. 

When used for washing the face and hands, a 2% per- 
cent, solution should be used. 

Carbolic acid acts only by direct contact. It can not 
be used as an air disinfectant, and spraying the room 



SPECIAL PROCESSES— CONTINUED 179 

or placing it about in open vessels has no effect on germs. 
How to Make Solutions. — Rule: Subtract from the 
index (95) the per cent, desired, and divide the remain- 
der by the per cent, desired. 

The index of a solution is the per cent, of purity, and 
in the case of carbolic acid it has been established for 
practical purposes at 9*5. 

Example : Make a 5% solution of carbolic acid. 

95 minus 5 equals 90 ; and, divided by 5, equals 18. 
The answer equals the parts of water to one part of 
carbolic acid. 

Therefore by adding 18 parts of water to one part of 
carbolic acid of 95% strength you will get a 5 per cent, 
solution. 

Rule: Multiply the total solution (reduced to 
ounces) by the percentage desired, and divide the result 
by the index. The answer is the ounces of carbolic 
acid. The total solution minus the ounces of carbolic 
equals the ounces of water. 

Example : Make one gallon of a 5% solution. 

One pint equals 16 ounces. 
One quart equals 32 ounces. 
One gallon equals 128 ounces. 

128 times 5 is 640 ; and, divided by 95, equals 6 14/19, 
or the ounces of carbolic. 

The total solution 128, minus the ounces of carbolic 
or 6 14/19 equals 121 5/19, or the ounces of water. 

The Cresols. — Tricresol is about three times as power- 
ful a disinfectant, bulk for bulk, as carbolic acid, and a 
1% solution is effective for all the ordinary purposes. The 



180 SPECIAL PROCESSES— CONTINUED 

presence of albuminous matter in the substance to be 
disinfected does not interfere seriously with the germi- 
cidal property of this chemical. The tricresol has an ad- 
vantage over carbolic acid in that it may be depended 
upon to kill bacterial spores. 

In the composition of tricresol we find a mixture of 
ortho-cresol, meta-cresol and para-cresol. Meta-cresol is 
a liquid and the other two are solid bodies of a crystaline 
formation, having a low melting point. These aforemen- 
tioned cresols are some of the impurities found in the 
carbolic acid of commerce. The group of cresols are the 
next higher homologue (chemicals having the same 
nature) to phenol. You may have trouble putting the 
cresols into solution, bv*t it can be done with the aid of 
soaps or by the cresol salts. 

The cresols are the accompanying ingredients to phenol 
and are both found in coal tar. The form of the tri- 
cresol is that of a clear or pinkish colored syrupy liquid. 
About a 2y 2 % solution can be made in water. Its poison- 
ous qualities are somewhat less prominent than carbolic 
acid, but its uses are the same. It is commonly used in 
a 1% solution. 

There are a number of cresol preparations now being 
used extensively throughout many hospitals. Harrington 
gives a list of those considerei as trustworthy disinfect- 
ants: Creolin, Lysol, Saprol, Solveol, Solutol, Saponate. 

Creolin contains 10% of cresols and a small amount 
of phenol held in solution by soap. It is a dark brown, 
thick, alkaline liquid, and forms a turbid, whitish emul- 
sion with water. It is considered at least equal, and per- 
haps superior, to phenol. 



SPECIAL PROCESSES— CONTINUED 181 

Lysol contains about 50% of cresols, with neutral pot- 
ash soap. It is a brown, oily liquid, and mixes with water 
in all proportions, and forms a soapy, frothy liquid. It is 
more powerful than phenol, and ranks with tricresol as 
a germicide. 

Saprol contains 2% of mineral oil and 80 per cent, of 
crude carbolic acid. It is lighter than water, and when 
thrown into it diffuses over the surface in a thin layer, 
which gradually yields its active ingredients to the strata 
below, so that in the course of a day the water becomes 
impregnated to the extent of 0.34%. It is superior as a 
general disinfectant to carbolic acid. 

Solveol is a concentrated watery solution of the cresols 
with sodium cresotinate. It contains over 2%% of cresols. 
It is non-irritating and much less toxic (poisonous) than 
carbolic acid. As a disinfectant it is considered the equal 
if not the superior of any of the cresol preparations. 

Solutol is a solution of about 60% cresols in sodium 
cresols. Those who have used this preparation claim for 
it superior germicidal powers to creolin, lysol, solveol 
and phenol. 

Saponate is prepared by melting pure soft soap in a 
dish on a steam bath with an equal quantity of crude car- 
bolic acid. The resulting solution is heated until it re- 
mains clear upon cooling and dissolves in distilled water. 
It is a clear Madeira colored fluid of neutral reaction, and 
soluble in all proportions of water, alcohol and glycerine. 
It is said to have a less disagreeable odor than lysol, be- 
sides being as satisfactory as the best pure lysol. 

Lime.— Lime may be used as a liquid disinfectant in 
the form of lime water, slaked lime, white-wash and milk 



182 SPECIAL PROCESSES— CONTINUED 

of lime. The lime in almost any of its forms is very caus- 
tic, and useful for the destruction of organic matter as 
well as germ life. It is on account of its efficiency and 
cheapness that it is a very valuable agent. 

(a) Lime water in .0074 per cent, solutions destroys 
typhoid fever germs in a few hours. Lime water in 
.0264 per cent, solutions destroys cholera germs in a few 
hours. So with these two examples as illustrations one 
must know that simple lime water solutions in very weak 
strengths are very applicable. 

(b) Slaked lime. — This is calcium hydroxide CaOEk, 
and is made by taking two pounds of lime and adding one 
pint of water. The mass becomes heated and the air 
escapes with a hissing noise. As a disinfectant it is very 
efficient, and is especially applicable for use in latrines, 
garbage barrels, etc. 

"(c) White-wash. — This is slaked lime mixed with 
about four times its volume of water to the consistency 
of a thick cream. It is useful for the disinfection, sweet- 
ening and brightening the walls of cellars, rooms, barns 
and stables, and in fact all outhouses in general. It is 
also very useful for the disinfection of excreta and like 
substances. 

(d) Milk of lime. — This is the same as white-wash. 
It can be used as a substitute for chloride of lime, but care 
should be taken that no air-slaked lime is used. The milk 
of lime is made from the hydrate of lime (slaked lime) 
by mixing one part of the dry hydrate of lime with eight 
parts by weight of water. The dry hydrate is made by 
mixing six parts of water by weight with ten parts of 
lime, and should be kept in an air-tight receptacle until 
used. 



SPECIAL PROCESSES — CONTINUED 183 

(e) Caustic lime. — This, too, is the same as white- 
wash. It should be used fresh. A quart of lime to a 
gallon of water. It is used for the disinfection of feces 
and evacuations. In typhoid or cholera, mix equal parts 
of lime and feces and allow to stand for an hour. 

(f ) Chloride of lime. — This is a gaseous non-poisonous 
disinfectant. It should be used in the fresh state and 
brought in direct contact with the infected material. One 
part to five parts of water is sufficient in strength. 

By dissolving six ounces of chloride of lime in one 
gallon of water, a 4% solution is obtained. Discharges 
from the bowels, kidneys, throat and lungs of a patient 
suffering from a contagious or infectious disease should 
be received in a vessel containing this solution and al- 
lowed to stand for an hour or more before being thrown 
into the vault or latrine. Chloride of lime can be pur- 
chased in quantities at a very reasonable sum and is a 
very reliable disinfectant. 

(g) Air-slaked lime or calcium carbonate. — "When 
water-slaked lime or calcium hydroxide is exposed to the 
air it will absorb still more carbon dioxide, and is thus 
converted into calcium carbonate, which has no disin- 
fectant properties. Therefore freshly slaked lime should 
always be used. 

(h) Liquid chlorinated lime. — CaOCk This is com- 
monly called bleaching powder, in the solid form. 

6 'American standard. 1 ' — Use 6 ounces of the powder 
to 1 gallon of water. This solution may be used for the 
disinfection of discharges and for the scrubbing of floors 
and woodwork. 

"Chamberland and Fernback Solution." — n ~ 



184 SPECIAL PROCESSES— CONTINUED 

1 part of powder with an equal part of water, and 
after standing one hour the mixture is filtered and a 
greenish liquid is obtained. One part of this greenish 
solution is added to ten parts of water for application to 
surfaces to be disinfected. It should be applied hot, with 
the room temperature elevated. 

"United States Army/ 9 — A 4 per cent, solution of 
chlorinated lime is used for the disinfection of feces. 

Carbol-sulphuric Acid. — This is made of equal 
parts of crude carbolic acid and concentrated sulphuric 
acid. Slowly add to the carbolic acid, which should be 
contained in a vessel that stands in water for the purpose 
of slacking the development of heat, an equal volume of 
concentrated sulphuric acid. From the mixture, solutions 
of from two or three per cent, can be made in water. 
This solution will be useful for the mechanical forms of 
disinfection. It has been used with good results in sewers 
during epidemics of water-borne diseases. 

Labarraque's Solution. — Labarrague's solution is an 
aqueous solution of several chlorine compounds of sodium, 
chiefly sodium hypochlorite and sodium chloride. The 
solution is clear and colorless when pure. Its germicidal 
properties depend upon the liberation of chlorine set free 
by the decomposition of the sodium hypochlorite. It is 
more expensive and somewhat less efficient than the 
solution of chlorinated lime and has no advantages over 
that substance. 



CHAPTER XVII. 

SPECIAL PROCESSES.— Continued. 

Solid Disinfectants. — Solid disinfectants are of more 
importance in the sanitation of communities and in the 
disposition of fecal matter from the intestines of infected 
living persons than for any other purposes. In the gen- 
eral prophylaxis against disease the disposition of the 
excreta takes an important position, that of preventing 
water-borne infection by the initial destruction of the 
pathogenic microbes within the excreta. 

After post-mortem examinations have been held, a 
solid disinfectant is also valuable for disinfection of the 
disturbed cavities and their contents. 

Magnesium Sulphate. — In specific cases of communi- 
cable diseases, where a post-mortem has been held, mag- 
nesium sulphate pure, or equal parts magnesium sulphate 
and sawdust, is recognized as an efficient disinfecting 
compound when placed in the exposed cavities. In this 
case it is known principally as a hardening compound, 
yet the disinfecting properties should not be lost sight of. 
In use as a disinfecting compound it should entirely 
surround the viscera or organs to be disinfected, and 
should also be placed between the various organs. 

Solid disinfectants are the more valuable for this pur- 
pose, as they will not fall away from the organs to be 
disinfected and will not gravitate to the base of the cav- 

185 



18(3 SPECIAL PROCESSES— CONTINUED 

ity, as would be the case should a liquid compound be 
used. In all forms of disinfection it is recognized as nec- 
essary that the infected material should be brought into 
actual contact with the disinfecting material. 

Granulated Zinc Chloride. — Granulated zinc chloride 
may also be used as a solid disinfectant in combination 
with magnesium sulphate, but the addition of the zinc 
adds but little to the disinfecting power of the compound, 
makes it more expensive to use, and makes it a poisonous 
compound such as is made illegal by the laws of the vari- 
ous states pertaining to the use of mineral poisons in 
and around the dead body. 

Lime. — Lime may be made in two ways, first by oxi- 
dizing native calcium, as follows: 

Ca + = CaO. 

or by calcining native calcium carbonate (CaCoa) such as 
chalk, limestone, or marble. Here carbon dioxide is thrown 
off, and the calcium oxide remains, as follows : 

CaCOs — CO* = CaO. 

Lime is used very commonly for the disinfection of 
stools coming from typhoid fever patients, tubercular pa- 
tients, etc. It must be remembered that to have an effect- 
ive disinfection of these stools, they must be covered 
with the lime about two times the volume of feces, allowed 
to stand in the vessel at least an hour before they should 
be permitted to be thrown into the latrine, cesspool, or 
sewer. It is best to disinfect the feces, that are considered 
infectious, before they are thrown into the latrine, so as 



SPECIAL PROCESSES— CONTINUED 187 

not to contaminate the surrounding soil from the latrine 
or the river water from the sewer. 

People commonly use lime to sprinkle about in the 
latrine, which is a good habit, and one which ought to be 
more prevalent in the country districts or in the crowded 
districts where there is no common sewer, (a condition 
which existed in Baltimore until recently). It must be 
remembered, though, that only the lumpy lime is to be 
used. The powdered dust which we find in the bottom 
of the lime houses and which is often used by many, is a 
form called air slaked lime and has no value as a disin- 
fectant. 

Lime was used in the earlier times in connection with 
the disposal of the dead. The body was surrounded, in 
a tight coffin, with twice its weight of fresh unslaked 
lime, without the addition of water or moisture in any 
form. 

It would be well to revive this custom for the disin- 
fection of those bodies that have become so putrid that 
it is impossible to do arterial or cavity embalming. Such 
a case would be where a body is found in the woods, or 
in the water, and has been dead so long that arterial and 
cavity injections are impossible. In these cases place 
about three inches of lime in the bottom of the casket, 
place the body in the casket as carefully as possible, then 
cover the entire body with the lumpy lime, and bury the 
body. 



CHAPTER XVIII. 

ANTISEPTICS. 

Antiseptics. — An antiseptic is any drug, chemical or 
agent which will retard the growth of microorganisms, 
but may not necessarily destroy them. All true chem- 
ical disinfectant agents are still antiseptic when diluted, 
provided that the dilution is not carried too far (i. e., 
bichloride of mercury has some trace of antiseptic power 
even at the enormous dilution of 1 :300,000). 

We append a list of chemicals giving the minimum 
strength at which they are classed as antiseptics : 

Acetic Acid 1 to 250 

Alcohol 1 to 10 

Alum : 1 to 222 

Aluminic Acetate 1 to 6000 

Aluminic Chloride 1 to 714 

Ammonium Chloride 1 to 9 

Ammonium Sulphate 1 to 4 

Arsenate Soda . . . 1 to 123 

Arsenious Acid 1 to 166 

Arsenite Potassium 1 to 8 

Benzoic Acid 1 to 909 

Boracic Acid 1 to 14L> 

Borax 1 to 114 

Camphor 1 to 214 

Calcium Chloride 1 to 225 

Carbolic Acid 1 to 333 

188 



ANTISEPTICS 



189 



Chloral Hydrate 1 to 107 

Chlorine 1 to 4000 

Chromic Acid 1 to 5000 

Copper Sulphate 1 to 11 

Creosote 1 to 200 

Ether 1 to 90 

Ferrous Sulphate 1 to 18 

Formaldehyde (aqueous) (40 per cent.) 1 to 30000 

Glycerine . 1 to 4 

Hydrochloric Acid * 1 to 375 

Hydrogen Peroxide 1 to 20000 

Lead Chloride 1 to 500 

Lead Nitrate 1 to 277 

Mercury Bichloride 1 to 14300 

Mercury Iodide 1 to 40000 

Osmic Acid 1 to 6666 

Phenol 1 to 333 

Potassic Arsenite 1 to 8 

Potassic Bichromate 1 to 909 

Potassium Nitrate 1 to 160 

Potassium Permanganate 1 to 285 

Salicylic Acid 1 to 1000 

Sodium Bicarbonate 1 to' 20 

Sodium Chloride 1 to 6 

Sodium Hyposulphite 1 to 3 

Sulphur Dioxide (Sulphurous Acid) 1 to 2000 

Sulphuric Acid 1 to 560 

Tannic Acid 1 to 207 

Thymol 1 to 1340 

Turpentine not known 

Zinc Chloride 1 to 526 

Zinc Sulphate 1 to 6 



190 ANTISEPTICS 

Antiseptics are also used on the hands of the embalmer 
to protect the skin against invasion of either disease pro- 
ducing or septic (putrefactive) bacteria. 

For this purpose the following solutions may be used : 

Mercury Bichloride 1 :1000 solution 

Potassium Permanganate .1 per cent, solution 

Lysol 1 per cent, solution 

Carbolized Vaseline 2 per cent, carbolic acid 

These are considered as standard for this purpose. 

Many cases of septicaemia (blood poison) would be 
prevented by the use of any of these chemicals in the 
proper strengths. Cases where the body has died from an 
eruptive communicable disease, such as erysipelas, should 
never be handled by the embalmer without first anoint- 
ing the hands with one of the above solutions. 

Slight abrasions of the skin, perhaps unnoticed, and in 
some instances perfectly healthy skin, have been known to 
allow the passage of a pathogenic (disease producing) mi- 
crobe into the healthy body. While the possibility of in- 
fection after anointing the hands with any of the above 
solutions is reduced to the smallest possible percentage. 

These solutions are especially valuable for those per- 
sons who oppose the use of rubber gloves on account of 
the hindrance to the perfect use of the fingers. 

Antiseptics are employed mainly to prevent or arrest 
decomposition of organic substances. Apart from em- 
balming purposes they are used for the preservation of 
food, and to prevent or restrain decomposition in organic 
refuse, or a precaution against rotting of timber and in 
many ways, especially in surgery. 



CHAPTER XIX. 

BLOOD SOLVENTS. 

Blood Solvents. — A blood solvent is a chemical that 
will prevent the coagulation of blood or will thin out 
thickened blood. 

The coagulation of blood being caused by the forma- 
tion and hardening of blood fibrin, a chemical to be a 
blood solvent must act against the formation of fibrin. 
Fibrin is an albuminous substance and is coagulated or 
hardened by bichloride of mercury, formaldehyde, and to 
the same extent by carbolic acid. Chemicals that are 
placed in solution with germicides such as formaldehyde 
and carbolic acid in order to prevent this coagulation, 
which would naturally occur were germicides used alone, 
are all called blood solvents. 

Under the heading of blood solvents we will find: 

Common salt (sodium chloride). 
Borax (sodium biborate). 
Sodium sulphate. 
Boracic acid. 
Oxalic acid. 

These chemicals, as blood solvents, can be used in so- 
lutions ranging from 1 per cent, to 3 per cent, in strength. 
There are 58,316.8 grains in a gallon of water; to get a 
1 per cent, solution it would take 1/100 of 58,316.8, which 

191 



192 BLOOD SOLVENTS 

would be 583.2 grains or approximately 1^4 ounces of the 
chemical to each gallon of water. A 2 per cent, solution 
would then require 2% ounces, and a 3 per cent, solution 
would require 3% ounces. Should these chemicals be used 
in embalming fluids, the number of ounces mentioned 
above for the various strengths would be for each gallon 
of finished fluid. 

Any fluid containing formaldehyde as a base could 
not be used where blood was to be removed either by 
drainage or aspiration unless a blood solvent was in- 
corporated into the solution. 

Diluting any standard finished fluid to one-half of its 
normal strength, as far as the first bottle for injection is 
concerned, adds to the effectiveness of the blood sol- 
vents by the extra dilution of the formaldehyde. 

For extreme effects in removing blood with the aid 
of a blood solvent, inject 1 per cent, solution of any of 
the blood solvents into the circulation before injecting 
any formaldehyde fluid. For this purpose an amount 
can be used ranging from one-half to one gallon, depend- 
ing on the size of the body and the condition of the blood. 

After blood has once clotted in the blood vessels of 
a body, blood solvents are powerless to dissolve them. 
All suitable precautions should be observed in the first 
place so as to prevent the coagulation from taking place. 

Blood solvents take a prominent part in the procedure 
against blood disco! orations, and Chapter XIV, "Anat- 
omy and Embalming," Nunnamaker-Dhonau, should be 
referred to for further information as to the practical ap- 
plications of these solutions. 



CHAPTER XX. 

BLEACHERS. 

Bleachers. — Bleachers are chemicals having the power 
(1) to restore the body tissues to their normal or natural 
color; (2) to remove or bleach out the color of any for- 
eign matter which may be in the circulation; (3) to 
bleach the skin in an effort to remove (a) the color of 
bile pigments, (b) putrefactive colors, (c) blood staining, 
especially those due to bruises, etc., (4) to whiten the 
appearance of the skin by an internal injection. 

Bleachers are a necessary part of the modern embalm- 
ing fluid of which much is demanded from a cosmetic 
standpoint. Formaldehyde, the base of modern fluids, 
great as its general power is, presents great faults, 
among which we find the tendency to make fast or set 
any color with which it comes in contact. 

It is the particular function of bleachers and blood 
solvents to eradicate this condition as much as possible, 
that the offending color and its cause be removed or de- 
stroyed before the setting action of formaldehyde takes 
place. 

The chemical coming under action (1) in the defini- 
tion is potassium nitrate (saltpetre.) The average 
strength at which this chemical is used is from 1 per cent, 
to 2 per cent, or from 1*4 to 2% ounces to each gallon of 
finished fluid. 

193 



194 BLEACHERS 

The chemicals used under action (2) are sodium 
biborate (borax), oxalic acid, and boracic acid. These 
chemicals are used principally in the attempt to re- 
duce the yellow color of jaundice and are preferably 
injected into the circulation in the form of a 1 to 3 per 
cent, watery solution before the embalming fluid is in- 
jected. The injection is made into an artery close to the 
center of the circulation, and a large vein is opened to 
allow the accumulated blood and bile pigment to flow 
from the body. An average betterment of at least 50 
per cent, should be expected from this treatment. For 
a 1 per cent, solution, l 1 /! ounces of chemical should be 
dissolved in 1 gallon of water. For a 2 per cent, solution, 
2y 2 ounces are dissolved. For a 3 per cent, solution, 3% 
ounces are dissolved. 

The chemicals coming under action (3) (a) are hy- 
drogen peroxide (full commercial strength) and zinc per- 
oxide, 10 per cent, solution. In this case an active oxi- 
dizing agent is wanted so that the organic impurity 
(biliverdin or bilirubin) may be bleached by oxidation. 

The chemicals coming under action (3) (b) are zinc 
chloride and hydrated choral. Zinc chloride, in combina- 
tion with other chemicals listed in the following formula 
has proven successful for the active bleachment of the 
greenish tinge of putrefaction. 

Formula Rx. 

Zinc chloride 5 grains 

Mercury bichloride 10 grains 

Alum 10 grains 

Grain Alcohol 4 fl oz. 



BLEACHERS I95 

For hardening add 

Formaldehyde 2 fl. oz 

The chemicals coming under action (3) (c) are acetic 
acid, 4 per cent, watery solution and sodium sulphate, 6 
per cent, watery solution. The chemicals are to be used 
by subcutaneous (hypodermic) injection into the affected 
part, after which they cause the disappearance of the 
blood color. Massaging is imperative to assist the dis- 
solving action. (For the removal of blood discolorations, 
Chapter XIX of this book and Chapter XIV " Anatomy 
and Embalming," Nunnamaker-Dhonau, should be con- 
sulted.) 

The chemicals coming under action (4) are hydro- 
chloric acid, 2 per cent, zinc chloride, 5 per cent, and hy- 
drated chloral, 2 per cent. For this purpose they would 
necessarily be a part of an embalming fluid, some of 
which contain one or more of the chemicals. The trend 
of modern thought is somewhat against the chlorine 
compounds mentioned above, as the natural paleness re- 
sulting from the use of these chemicals is considered an 
inferior effect. 

Extreme bleaching is considered secondary to a good 
natural life-like appearance. 

The following solution is especially valuable for 
bleaching bones for anatomical study. 
Formula Rx. 

Chlorinated lime 10 lbs. 

Soda ash ..10 lbs. 

Water 20 gal. 



CHAPTER XXI. 

INSECTICIDES. 

Insecticides. — In our work for the prevention of dis- 
ease the insecticides should not be overlooked. Just be- 
cause a chemical is a good disinfectant does not denote 
that it is a good insecticide. An insecticide is any drug, 
chemical, or agent that will absolutely kill insect life. 
Many agents have a destructive action upon flies, fleas, 
mosquitoes, and vermin. Among these may be men- 
tioned : 

Arsenic, acetoarsenite of copper (Paris green), arsen- 
ite of copper (Scheeles green), bisulphide of carbon, hy- 
drocyanic acid gas, petroleum, pyrethrum, sulphurous 
acid gas. 

As the fly, mosquito, flea, and other insects are known 
or suspected of conveying the infection of some of the 
communicable diseases, it is important that the disin- 
fector know how best to destroy this class of vermin. The 
general subject of protecting the individual against the 
bites, dangers, annoyances, of flies, mosquitoes, etc., and 
the subject of ridding a community of these dangerous 
vermin, is a very important one from an economic and 
hygienic standpoint, and is discussed under the particular 
disease of which they form a part. At this time, how- 
ever, only those agents are considered which are useful 
to the disinfector in exterminating vermin, in a room, or 
building in order to prevent the spread of the disease. 
196 



INSECTICIDES 197 

The mosquito is known to transmit the infection of 
several diseases. This insect is the intermediate host for 
the parasites of malaria, yellow fever and filariasis. The 
microorganisms are taken into the stomach of the mos- 
quito with the blood it sucks. From the stomach the 
parasites pass into the general body cavity, or the glands 
of the mosquito, and are extruded again through the in- 
sect's proboscis under the skin of its victim. That is to 
say, that the mosquito inoculates the infectious princi- 
ples into the system just as we would experimentally in- 
oculate an animal by means of a hypodermic syringe. 

On the contrary, the fly, ant, flea, and other insects, 
transmit the infection of disease in quite another way. 
For instance, flies spread the infection of typhoid fever, 
cholera, plague, and anthrax by having the infection 
smeared upon their legs and upon the external surfaces 
of their bodies. This is readily understood when we re- 
call the habit of flies feeding upon and breeding in the 
decomposed meats, dejecta, and other matters apt to con- 
tain the infectious principles of the above named dis- 
eases. 

The investigation of the Army Medical Commission 
during the Spanish- American war practically established 
the fact that the fly is an important factor in the dis- 
semination of typhoid fever. Victor Vaughan, a member 
of that commission, stated that flies undoubtedly served 
as carriers of typho-id infection, giving the following rea- 
sons for his belief: "They swarmed over fecal matter in 
the latrines. They visited and fed on food prepared for 
the soldiers in the mess tents. In some instances, when 
lime had been recently sprinkled over the contents of the 



198 INSECTICIDES 

latrines, flies with their feet whitened with lime were 
seen walking over the food. Officers, whose tents were 
protected by means of screens, suffered less proportion- 
ately from typhoid fever than those whose tents were not 
so protected. Typhoid fever gradually disappeared in 
the fall of 1898 with the approach of cold weather and 
the consequent disabling of the fly." 

It is perfectly easy to understand how a fly, alighting 
upon the skin of a smallpox patient, and contaminating 
its legs, proboscis and body with the fluid exudates from 
the vesicles and pustules, may carry this highly infec- 
tious material to other persons in the same house or to 
neighboring houses. 

Flies, fleas, ants, and other insects spread the infec- 
tious principles of many communicable diseases in an- 
other way than simply this mechanical conveyance of the 
bacteria upon their external parts. These insects feed 
upon organic matter containing the infective principles, 
which live a variable length of time in the intestinal tract, 
and the live and virulent microorganisms are deposited 
with the dejecta. In this way infection is transmitted 
from infected materials to man, from animals to man, and 
from man to man. 

It is believed that the biting insects, such as flies, 
fleas, ants, etc., do not inoculate the parasites under the 
skin when they bite. When this does occur, it is proba- 
bly due to an accidental contamination of the mouth or 
biting parts of the insect with the infective germs. In 
other words, the transference seems to be mechanical. 
The insect does not act as an intermediate host, and the 
bacteria do not pass through the various phases of de- 



INSECTICIDES 199 

velopment in the insect, as is the case with the malarial 
parasite and mosquito. 

The flies, fleas, ants, etc., deposit the infectious ma- 
terial on the skin with their excrement, and in other ways. 
The virulent infection is rubbed into the little wounds or 
scratched into the skin as a result of the irritation caused 
by the bites, thereby setting up the disease. 

For the reason that plague is transmitted through the 
agency of rats, a paragraph is introduced upon the means 
commonly employed to destroy these rodents. 

Arsenic. — The arsenical compounds, according to Mar- 
latt, have supplanted practically all other substances as 
a food poison for biting insects. The two arsenicals in 
most common use and obtainable everywhere are Paris 
green and London purple. Scheele's green and arsenite 
of copper are less known and less easily obtainable, but 
in some respects are better than the first named poisons, 
as will be shown later. The use of powdered white ar- 
senic is not recommended on account of its corrosive ac- 
tion as well as the fact that it is apt to be mistaken for 
harmless substances. 

Paris green is a definite chemical compound of arsenic, 
copper and acetic acid (known as aceto-arsenite of cop- 
per), and should have a nearly uniform composition. It 
is a rather coarse powder, or, more properly speaking, 
crystal, and settles rapidly in water, which is its great- 
est fault so far as the making of suspensions of this sub- 
stance is concerned. The cost of Paris green is about 20 
cents per pound. 

Scheele's green is similar to Paris green in color and 
differs from it only in lacking acetic acid, in other words, 



2oo Insecticides 

it is simply arsenite of copper. It is a finer powder than 
Paris green and therefore is more easily kept in sus- 
pension, and has the additional advantage of costing only 
half as much per pound. 

London purple is a waste product in the manufacture 
of aniline dyes, and contains a number of substances, 
chief among which are arsenic and lime. It is quite vari- 
able in the amount of arsenic it contains and therefore is 
not so effective as the green poisons. It comes in a fine 
powder and is more easily kept in suspension than Paris 
green. It costs about 10 cents per pound. 

Arsenite of lead is prepared by compounding approx- 
imately 3 parts of arsenite of soda with 7 parts of acetate 
of lead (white sugar of lead) in water. These substances 
when pulverized, unite readily and form a white precipi- 
tate, which is more easily suspended in water than any of 
the arsenical compounds. Bought wholesale the acetate 
of lead costs about 7^ cents per pound, and the arsenite 
of soda about 7 cents per pound. Its use is advised where 
excessive strengths are desirable and upon delicate plants 
where otherwise scalding is likely to result. 

The arsenical compounds may be applied in one of 
three ways: (1) in suspension, as poisoned waters 
mainly in the form of sprays; (2) as a dry powder blown 
or dusted about the infected areas; (3) or as a poisoned 
bait. 

It must be remembered that the arsenicals are very 
poisonous, and should be so labeled, and care taken to 
prevent accidents. 

An average of one pound of either Paris green, 
Scheele's green, or London purple to 150 gallons of water 



INSECTICIDES 201 

is a good strength for general purposes in using the wet 
method. The powder should first be made up into a thin 
paste in a small quantity of water, and if the suspension 
is to be used upon plants, vegetables, or about foliage, 
an equal amount of quicklime should be added to take up 
the free arsenic and remove or lessen the danger of scald- 
ing. 

For the distribution of dry poison the arsenicals are 
diluted with 10 parts of flour, lime, or dry gypsum. 

Bisulphide of Carbon. — Bisulphide of carbon is a very 
efficient insecticide, but a dangerous one on account of 
its inflammable and explosive nature. When pure it is a 
mobile, colorous liquid, with an agreeable ethereal odor. 
But often it has a more or less fetid odor from the pres- 
ence of other volatile compounds. The liquid must be 
kept in well stoppered bottles, in a cool place away from 
the light and fire. It evaporates very rapidly at the room 
temperature, so that in using this substance in a confined 
place it is sufficient to pour it into open vessels, and it 
will quickly pass into the air as a gas, in which state it 
is an efficient insecticide. It is very inflammable, more so 
than ether, and burns with a pale blue flame, yielding 
sulphur dioxide and carbon dioxide or monoxide. 

Upon the authority of Howard and Marlatt this sub- 
stance distributed about the pantry or room in open ves- 
sels will evaporate, and if used in proper quantities will 
destroy roaches and other vermin. Unless the room can 
be very tightly sealed, however, the vapors disappear so 
rapidly that its effect will be lost before the roaches are 
killed. 

In the use of this substance, every precaution must be 



202 INSECTICIDES 

taken to see that there is no fire, lighted cigar, etc., in or 
about the premises during the treatment, on account of 
its inflammable and explosive nature. It is also deadly 
to the higher animals, so that apartments should be thor- 
oughly aired after its use. 

According to Hinds, shallow tin pans or plates make 
good evaporating dishes for carbon bisulphide. The 
larger the evaporating area the better. There should 
be about one square foot of evaporating surface to every 
twenty-five square feet of floor space, and each square 
foot of evaporating surface should receive from one-half 
to one pound of liquid. These figures are only suggestive 
and approximate. Pans should be placed as high in the 
room as possible, since the vapor is so heavy that it 
settles most heavily to the lower parts. Care should be 
taken, when placing the pans, to see that they are nearly 
level, so as to hold the liquid, though ordinarily no partic- 
ular harm is done if some of it is spilled. It should not 
be found necessary to lose time in adjusting such things 
after the application is begun. 

If there are special places which are difficult of access 
or treatment with pans, cotton waste, bundles of rags, 
or the like may be saturated with and thrown into the 
places. 

Everything should be done to avoid unnecessary de- 
lays and to facilitate the rapid exposure of the liquid. 
If the liquid is bought in large quantities, smaller re- 
ceptacles may be provided for transferring it to the pans. 

Hydrocyanic Acid. — Hydrocyanic acid is extremely 
poisonous to all forms of life, killing roaches, bed bugs, 
mosquitoes, fleas, flies, rats and mice with great certainty 



INSECTICIDES 203 

and very quickly. It is much less poisonous to the veg- 
etable forms of life. (See page 170). The gas is much 
used in greenhouses for the destruction of insect pests, 
and for the scale insects and other parasites of the fruit 
trees. 

Hydrocyanic acid has a distinct place in the disinfec- 
tion of granaries, stables, ships, barns, outhouses, and 
other uninhabited structures infested with vermin. But it 
should not be used in the household, or any other in- 
habited building, as the least carelessness with it would 
probably mean the loss of human life. (See page 170 for 
its action as a disinfectant). 

Petroleum. — Petroleum, kerosene or coal oil is a very 
valuable insecticide, but of limited application, as it 
must be used in the liquid form, its vapor being too in- 
flammable for consideration in this connection. 

As a remedy for mosquitoes kerosene has proved very 
effective when applied as recommended by L. 0. Howard. 
He recommends a light grade of fuel oil, and applied at 
the rate of 1 ounce to 15 square feet of water surface. 
It forms a uniform film over the surface and destroys all 
forms of aquatic insect life, including the larvae of the 
mosquito and the adult females coming to the water to 
lay their eggs. The oil must be renewed every few weeks, 
depending upon the temperature and other circumstances. 

It is employed to kill the larvae of the mosquitoes in 
pools, still ponds, stagnant water, water buckets, and 
other small collections of water not of value for their 
fish. In large bodies of water it is not nearly so effec- 
tive, as the oil is blown about by the wind, thereby un- 
covering the greater part of the surface. An apparatus 



204 INSECTICIDES 

devised by Dr. Doty is of use in distributing the petro- 
leum over the surface of ponds. It consists of a wooden 
framework carrying the oil pipes which deliver the pe- 
troleum through many small openings projecting six 
inches or so below the surface of the water. The float 
is drawn over the pool while the petroleum is allowed to 
escape, thus coating the entire surface, and emulsifying 
some of the oil with the water, which intensifies its insect- 
icidal action. 

Petroleum is also useful against roaches, bed bugs, 
and other forms of vermin when used by direct applica- 
tion or by spraying either in the form of pure oil or as 
emulsion with water, soap, or milk. 

Pyrethrum. — Pyrethrum is a popular and much used 
insecticide because it is comparatively cheap and non- 
poisonous to the higher organisms, but unfortunately it 
is not very powerful for the destruction of roaches, ants, 
mosquitoes, bed bugs, fleas, flies, etc. 

Pyrethrum, also sold under the trade name Buhack 
and Persian insect powder, is the flowers of the chrysan- 
themum roseum and the chrysanthemum careneum, both 
hardy perennials and resembling chamomile in appear- 
ance. 

According to Kalbrunner, 4 grains of the pure powder 
sprinkled on a fly in a vial should stupefy it in one min- 
ute and kill it in two to three minutes. This is used as a 
test for the strength of pyrethrum. 

It acts on insects externally through their breathing 
pores, and according to Marlatt, is fatal to many forms 
of biting and sucking insects, being chiefly valuable 
against household pests, such as roaches, flies and ants. 



INSECTICIDES 205 

It is used either as a dry powder or by its burning 
fumes. As a dry powder it may be used pure or mixed 
with flour, in which form it should be puffed about the 
room, especially into the cracks. Against mosquitoes the 
powder should be burned in the room, and if used in suffi- 
cient strength, it will kill many of these insects, but it 
can not be depended upon for the destruction of mos- 
quitoes, infected with yellow fever, for some of the in- 
sects are only stupefied. They must be gathered up and 
destroyed after the fumigation. 

The regulations of the United States army require the 
burning of five pounds of pyrethrum for each 1,000 cu. 
ft. of air space, for the destruction of mosquitoes in con- 
fined places. 

Sulphur. — Sulphur is one of the most valuable insect- 
icides we possess. It may be used in the following forms : 
Sulphurous acid gas, produced and used according 
to the methods given for bacterial disinfection (page 165), 
will kill roaches, bed bugs, flies and all kinds of vermin, 
including rats and mice. This substance, therefore, is 
exceedingly useful in disinfecting in such diseases as 
plague, yellow fever, malaria and insect-borne infections. 
The time of exposure necessary to kill insects and vermin 
is shorter than that given for sulphur dioxide as a germi- 
cide. One hour is ample for mosquitoes, and two hours 
for rats. 

Very dilute atmospheres of the gas will quickly kill 
mosquitoes. It is very efficacious for this purpose when 
dry as when moist, whereas the dry gas has practically 
no power against bacteria. Contrary to formaldehyde, 
it has surprising powers of penetration through clothes 



206 INSECTICIDES 

and fabrics, killing the mosquitoes even when hidden be- 
neath eight layers of toweling, in one hour's time, and 
with very dilute proportions. This substance, so long 
disparaged as a disinfectant because it fails to kill 
spores, must now be considered as holding the first rank 
in disinfection against insect-borne diseases. 

Sulphurous acid gas prepared according to the 
methods given on page 165 is probably the best insecticide 
of the sulphur group. Its action is more penetrating, and 
is successful in the rapid destruction of all vermin and 
insects. 

The flowers of sulphur is very efficient in its pow- 
dered form as an insecticide. It may be applied in several 
forms, the simplest of which is to merely sprinkle the dry 
sulphur about the places where the insects are found. The 
flowers of sulphur may also be advantageously combined 
with other insecticides, such as kerosene emulsion, resin 
wash, or a soap wash, mixing it first into a paste and then 
adding it to the spray tank in the proportion of 1 to 2 
pounds to 50 gallons. 

The sulphur in its dry form must be directly applied 
to the places where the insects are found, and is thus used 
more for the destruction of the mites and rust of plants 
and fruit. It has but a limited use against bed bugs, ants, 
roaches, etc., and is practically useless against the winged 
insects. 

Bisulphide of lime is a good liquid insecticide where a 
liquid is applicable. It may be very cheaply prepared 
by boiling together for an hour or more in a small quan- 
tity of water, equal parts of flowers of sulphur and stone 
lime. A convenient quantity is prepared by taking 5 



INSECTICIDES 207 

pounds of sulphur and 5 pounds of lime, and 
boiling in 3 or 4 gallons of water until the ingredients 
combine, forming a brownish liquid. This may be diluted 
to make 100 gallons of spray. 

Formaldehyde Gas. — Formaldehyde gas, while holding 
the front rank as a germicide, is a feeble insecticide. It 
seems to have no effect whatever upon roaches, bedbugs, 
and insects of this class, even after prolonged exposure to 
very high percentages of the gas. While very irritating, 
this substance is not toxic for the higher forms of animal 
life. 

Mosquitoes may live in a very weak atmosphere of the 
gas over night. It will kill them, however, if it is brought 
in direct contact in the strength and time prescribed for 
the bacterial disinfection. For this purpose any of the 
accepted methods for evolving the gas is applicable, but 
the methods which liberate a large volume of the gas in 
a short time are more certain than the slower ones. 

Direct contact between the insects and the gas is much 
more difficult to obtain in ordinary room disinfection 
against mosquitoes than against germs, because the sense 
of self-protection helps the former to escape from the 
effects of the irritating gas. They hide in the folds of 
towels, bedding, clothing, hangings, fabrics and out-of- 
the-way places where the formaldehyde gas does not pen- 
etrate in sufficient strength to kill them. The gas is 
polymerized and deposited as paraform in the meshes of 
the fabrics, which prevents its penetration, and large 
quantities are lost by being absorbed by the organic mat- 
ter of the fabrics, especially woolens. In our tests, when- 
ever the insects were given favorable hiding-places, such 



208 INSECTICIDES 

as in crumpled paper or in toweling, they quickly took 
advantage of the best place for themselves and often 
escaped destruction. 

There is a striking analogy between the strength of 
the gas and the time of exposure necessary to penetrate 
the fabrics in order to kill mosquitoes, and the strength 
and the time necessary to penetrate in order to kill the 
spores of bacteria. 

Mosquitoes have a very lively instinct in finding cracks 
and chinks where fresh air may be entering the room 
or where the gas is so diluted that they escape destruction. 
They are able to escape through incredibly small open- 
ings. Some of the smaller varieties such as the stegomia 
fasciata can get through a wire screen having twelve 
meshes to the inch. Therefore, formaldehyde gas can 
not be trusted to kill all the mosquitoes in the room which 
can not be tightly sealed. 

It is concluded that to succeed in killing all the mos- 
quitoes in a closed space with formaldehyde gas, the 
following definite requirements are essential. A very 
large volume of the gas must be liberated quickly, so that 
it may diffuse to all parts of the space in sufficient con- 
centration. The room must have all the cracks and chinks 
where the insect may breathe the fresh air carefully 
sealed by pasting strips of paper over them. The room 
must not contain heavy folds of drapery, clothing, bed- 
ding, or fabrics in heaps or so disposed that the insects 
may hide away from the full effects of the gas. 

The Destruction of Rats on account of the Plague. — 
The ordinary methods of catching rats by such means as 



INSECTICIDES 209 

cats, dogs, ferrets, traps, poisoned bait, etc., are all useful 
in ridding a community of this rodent. 

In Glasgow, Japan, and other places where plague 
prevailed as an epidemic, thousands of rats, many of 
them infected with plague, were caught and disposed of 
by the authorities offering a price for the heads. Experi- 
ence has shown that this reward must not be too large, 
else persons will breed the rodents as a paying invest- 
ment. 

While the extermination of the rats in a city or a 
community of considerable size may be a hopeless under- 
taking, their destruction on board a ship, in a stable, 
granary, or other limited area, is quite possible, although 
it takes time, care and much patience. 

The handling and the final disposition of rats suffering 
with or dead with the plague, is a matter requiring 
special care in order to guard against the infection. Ac- 
cording to Simond, the fleas transmit the infection from 
the rats to man. He states that the flea will not leave 
the rat for man as long as the body of the rat is warm. 
Therefore, in the handling of rats, whether dead or alive, 
the hands should be protected with gloves and other 
precautions taken to guard against the fleas. 

The bodies of dead rats should be cremated at once, 
and all surfaces exposed to the infection disinfected with 
a bichloride solution or carbolic acid. 

The rats on board a ship or in a confined place may 
best be destroyed by sulphur fumigation. Careful search 
must be made for the dead bodies. This same substance 
is useful in destroying or in driving out the rats from a 
sewer, in fighting the infection of plague in a community. 



210 INSECTICIDES 

For this purpose the sulphur is burned in a sulphur fur- 
nace and the fumes are driven into the sewer by a centrif- 
ugal fan. 

Rats may also be killed in a confined place by the use 
of other poisonous gases, such as hydrocyanic acid gas, 
carbon bisulphide, or even carbon dioxide. Formaldehyde 
gas can not be trusted to destroy these rodents. 

The carbon dioxide is evolved by simply burning 
charcoal in open fires and taking care to close the room 
or hold of the vessel very tightly. 

The substance known as Danyz's virus is sometimes 
useful in helping to rid a locality of these rodents, but 
it is far from being a sure means in the fight against rats. 

Insecticides and Their Uses around the Dead Body. — 
Insecticides are frequently of the utmost importance in 
combating the work of the blow fly or other insect on 
or in the body. From the work of the blow fly, maggots 
result, which if not killed, will destroy the entire body 
in a few days. 

The ordinary embalming fluids are not insecticides 
and will not serve to kill these insects or their causes. 
Mineral oils such as petroleum, benzine, gasoline and 
naphtha are standard agents for the destruction of in- 
sects around the dead body. 

The action of these oils is swift and decisive and in- 
sect life is not possible in their presence. The oils above 
mentioned are sprayed on or in any affected part, and 
where the maggots may be seen coming from any orifice, 
the oil is injected directly into that orifice. 



CHAPTER XXII. 

DEODORANTS. 

Deodorants. — A deodorant is any drug, chemical or 
agent having the power of destroying or masking odor. 
A deodorant may not destroy the germs that cause the 
odor, or may not even arrest their development. De- 
odorants are of two kinds, true and false. 

A true deodorant is one that acts chemically with the 
cause of the odor and destroys the odor by killing the 
cause. An example of a true deodorant would be formal- 
dehyde. 

A false deodorant is one that merely covers up an- 
other odor with a more characteristic one of its own. 
Examples of false deodorants are flowers, perfumes, etc. 

Among aerial deodorants nitrous acid is one of the 
most powerful. Chlorine and the fumes given off by 
moist chloride of lime are also potent, and act by oxida- 
tion of organic matter. They decompose sulphurated 
hydrogen, which is an important constituent of the gases 
of putrefaction. Hydrochloric acid fumes, like chlorine, 
neutralize the free ammonia and ammonium carbonate. 
Sulphurous acid may perhaps act in some degree as a 
reducing agent and also as an antiseptic, but its chief 
effect is to overpower the effluvia and necessitate free 
ventilation. Fumes of wood, tar or paper are quite use- 
less except for the same reason. 

211 



212 DEODORANTS 

Of the solid or liquid deodorants, ferrous sulphate and 
copper sulphate act mainly by removing the sulphuretted 
hydrogen as a precipitate; potassium permanganate sim- 
ply oxidizes; carbolic acid and the essential oils exert an 
antiseptic effect and so check further decomposition, 
while at the same time their powerful odor masks all 
others. The ozone and the peroxide of hydrogen which 
is believed to be associated with the essential oils may 
effect a small amount of oxidation. 

Formalin. — Formalin is a true deodorant. It does not 
mask one odor with another, but unites with the albu- 
minous matter to form new compounds that are both 
odorless and sterile. 

Formalin also readily unites with the nitrogenous pro- 
ducts of decay, fermentation and decomposition, forming 
new chemical compounds that are odorless. 

Chlorinated Lime. — This substance as a deodorant de- 
pends not only on its destructive influence upon organic 
matter and its germicidal properties, but also upon its 
great affinity for water, thus acting as a dessicant. Tt 
also has the power of combining with hydrogen sulphide 
and the volatile ammoniacal compounds of decomposition 
and decay. For this purpose it should be used in the dry 
form. Chlorine is the chief active constituent. Use in 
strengths of from 2 to 5 per cent. 

Copper and Iron Sulphate. — Disinfectants and deodor- 
izers are recommended for the suppression of offen- 
sive odors from privy vaults or latrines, cesspools, feces, 
etc, 



DEODORANTS 213 

For this purpose use 4 pounds of the salt to 6 quarts 
of water, for every cubic yard of matter. 

It must be said, however, that they will destroy bad 
odors only to a certain degree, but at that they are better 
deodorants than disinfectants. 

Potassium Permanganate. — As a deodorant use four 
ounces of the salt to a gallon of water, for every cubic 
yard of matter. 

Piatt's Chlorides. — A liquid chlorine compound formed 
by combining: 

Aluminum sulphate, 170 parts 
Zinc chloride, 40 " 

Sodium chloride, 55 " 

Calcium chloride, 85 " 

Water, 1,000 " 

This compound is sold by all druggists and is ex- 
tremely valuable in deodorizing sick-rooms, etc. The 
active deodorizing agent is chlorine gas. In the deodor- 
ization of rooms where a death has occurred this com- 
pound will be preferable to formaldehyde fumes, since 
the compound has little or no odor. It can be used by 
saturating a cloth and hanging the cloth on some con- 
venient object in the center of the room. 

After a body is embalmed and placed in the casket 
in the proper manner, there should never arise any occa- 
sion where a deodorizer should be used, yet if something 
should occur to warrant the use of one, Piatt's chlorides 
sprayed on the underclothing of the body, will be found 
valuable, 



214 DEODORANTS 

Dry Earth. — Dry earth promotes desiccation of ex- 
creta, thus preventing putrefactive changes while absorb- 
ing the odors. It has no inherent germicidal or antiseptic 
properties, but is a useful means of disposing of dejecta 
in camps and country places where lime and other chem- 
icals are not at hand. Earth, then, is to be only consid- 
ered as a deodorant. 

Charcoal. — Charcoal will absorb the malodorous gases 
arising from putrefying and fermenting materials, but it 
is inert so far as its power to destroy the cause of these 
processes is concerned. 

Ashes. — Ashes, also, are to be considered as a deodor- 
ant for dejecta and other materials. In actual practice it 
is used in latrines for deodorizing fecal matter. It is not 
quite as good as clay or loam for this purpose, but is 
better than sand or gravel. It also has slight antiseptic 
and germicidal properties because of the mineral acids 
found. 



CHAPTER XXIII. 

EMBALMING FLUIDS. 

Embalming Fluids. — Embalming fluids are to the em- 
balmer what drugs and medicines are to the physician. 
Heretofore this subject has been neglected for various 
reasons, chief among which was the usual author's rela- 
tion to some commercial enterprise, closely followed by 
the apparent apathy of students and practitioners to this 
important subject. It is difficult to understand why the 
men who have used embalming fluid in the past were not 
more interested in knowing the chemical ingredients 
usually found in fluids and in studying their actions. 
It is the profound belief of the authors that nothing 
certain can be accomplished by using an embalming fluid 
with which the practitioner is not familiar, especially 
as to its actions and strength. It has been the practice 
in the past for some practitioners to try each and every 
concoction on the market, jumping from pillar to post, 
and never being certain as to just how the fluid is going 
to act after it permeates the systemic circulation. This 
should not be construed as to mean that the practitioner 
should be satisfied with one brand of manufactured fluid 
to the exclusion of all others. Our meaning is far from 
that. Any solution manufactured for use as an embalm- 
ing fluid which contains a germicide of proper strength, 
fortified by antiseptic salts, should be valuable as a pre- 

215 



216 EMBALMING FLUIDS 

servative agent. Unless this fluid be watched and studied, 
however, especially as to its actions in and around all 
classes of bodies, and the proper amount of the solution 
is used for each individual case, there will likely be times 
when bad results will come. 

Bad Results with Embalming Fluids. — In times like 
this the practitioner should carefully review his treat- 
ment for — 

(1) Correctness of the amount of fluid injected. 

(2) Correctness of the circulation obtained. 

(3) The possibility of neutralization of the preserva- 
tive action of the fluid within the body by the elements of 
an opposite nature. 

(4) Correctness of the strength of fluid used. 

We have observed a varied action of any given fluid in 
the presence of the following conditions : 

(1) Injection made before the setting in of natural 
rigor mortis in which the body tissues were alkaline in 
reaction. 

(2) Injection made during or after the setting in of 
natural rigor mortis in which the body tissues were acid 
in reaction. 

Most modern embalming fluids are alkaline in reaction 
and are best suited in normal strengths for use before 
rigor mortis begins in the body. - To this fact is due the 
difficulty one has of securing preservation in cases where 
putrefactive changes have appeared in the body. Putre- 
factive changes follow rigor mortis, the coming on of 
which changes the body from an alkaline to an acid 
reaction. 



EMBALMING FLUIDS 21? 

It is only logical to believe that an embalming fluid 
of the same nature as the body would work more effi- 
ciently with the conditions within the body than a fluid 
of an opposite nature. 

These contentions are partly proven by the varied 
actions of any fluid of standard formula in which one 
effect is obtained in one case and another is obtained in 
the following case. 

The practitioner is often puzzled by the inability of 
the fluid to bring the firmness to the tissues that usually 
characterizes the action of the fluid he uses. This is not 
the fault of the fluid, excepting that it is not suited ex- 
actly for the condition within the body, which is of an 
acid reaction instead of the alkaline reaction usually met 
with in bodies dead only a short time. 

In the case of a formaldehyde fluid, it appears that the 
coagulable matter in the tissues, the coagulation of which 
is described as rigor mortis, having been once coagulated 
and then released by the liberation of free acids in the 
body, does not readily respond to a normal injection. 
Preservation itself may be established regardless of this 
fact, but as many practitioners feel that they must see 
and feel evidences of hardening they are frequently both- 
ered by its absence. 

At the present time all we can recommend in case the 
tissues do not respond to the hardening properties of the 
fluid, is to use a stronger concentration for the last part 
of the injection. 

In advising this it is not our wish to be quoted as 
favoring the hardening of a. body, as any treatment look- 
ing forward to a hardening effect must needs detract from 



218 EMBALMING FLUIDS 

the life-like appearance so well thought of by the public 
whom we must please. 

Ideal Condition of Body. — The ideal condition in which 
to place the body is one in which the under tissues of the 
body are firm and the skin of the exposed parts is as 
soft as can be made. With this condition in effect the 
beautifying of the face is most simple. 

The first step to be taken in the use of an embalming 
fluid is to use a 50% diluted solution for the first injection, 
to be followed by a more normal finished fluid. 

This, as you will see, requires the weakening of the 
fluid 50% for the first injection. Many practitioners are 
of the opinion that this will be detrimental rather than 
beneficial. This, however, is not so, as it has been proven 
many times that the weaker the fluid used the more can 
be placed in the circulation and the better the general 
distribution will be. In other words, it may be stated 
in speaking of formaldehyde fluids, that a solution con- 
taining 2!/2% formaldelryde will penetrate at least 50% 
further into the general capillary network than a normal 
fluid containing 5% formaldehyde, and as the foundation 
of all preservative treatments is the importance of bring- 
ing the tissues to be disinfected and preserved into actual 
contact with the preserving and disinfecting solution, it 
would appear that this dilution would be beneficial rather 
than detrimental. 

The Problem of the Circulation. — The problem of ob- 
taining a circulation is much more difficult since formal- 
dehyde is the base of many fluids. When arsenic was the 
base, the securing of a circulation was more simple. Other 



EMBALMING FLUIDS 219 

bases in use at this time are creosote and carbolic acid, 
neither of which present circulation problems such as is 
presented by formaldehyde. Not only does formaldehyde 
contract the capillary systems, but in excessive strengths 
coagulates the blood, especially if attended by an insuffi- 
cient amount of blood solvent material in the fluids. 

Material that will aid in preventing the darkening of 
the blood in the body is also essential, and these come 
under the head of bleachers. For a complete list of 
bleachers and blood solvents Chapters XIX and XX 
should be consulted. 

So far we have mentioned germicides, antiseptics, 
blood solvents and bleachers. The chemicals having these 
actions, if properly compounded, should give the very 
best results, providing a sufficient quantity of the fluid 
is used and the proper strength of solution is used. 

Dry, Medium and Moist Tissues. — We mention the 
term proper strengths for this reason: there are three 
classes of bodies with which we come in contact: 

(1) Those presenting a dry condition of the tissues — 
i. e., tubercular and anemic cases, old age, senility, etc. 
For these cases the finished fluid should be diluted at least 
one-half for the first bottle and one-fourth for all subse- 
quent bottles. This dilution is advised on account of the 
previous dryness of the tissues discounting most of the 
chance for intravascular dilution of the fluid, and the effi- 
ciency of the fluid being unimpaired to a large degree. 

(2) Bodies dead of non-exhausting diseases, such as 
pneumonia, cerebral hemorrhage, death by accident where 
no loss of blood has occurred, etc. The requirements in 
these cases are the use of a £0% diluted fluid for the 



220 EMBALMING FLUIDS 

first part of the injection, followed by the normal fluid 
for the second, third and fourth parts of the injection — 
i. e., if an arterial injection of one gallon is used, the first 
quart should be half strength and the following three 
quarts full strength finished fluid ; other quantities in pro- 
portion. 

(3) Bodies dead of kidney diseases, drowning, etc., in 
which the capillaries are filled with liquids and the tis- 
sues can be said to be saturated. In cases of this character 
the aim of the embalmer should be to inject one bottle 
of normal finished fluid and to follow that with a strength- 
ened solution until preservation is assured. The strength- 
ening can be at least one-fourth over normal, and in these 
days of concentrated fluid this manipulation of the 
strength of your fluid presents no difficulties. 

In cases of this kind there is apt to be an intravascular 
dilution of the fluid which would reduce the strength of 
the fluid within the body until without the strengthening 
beforehand the fluid would be far below the efficient point. 

Amount of Fluid to Inject. — In all cases it must be 
remembered that the amount of fluid used in a body 
should bear a fairly close relation to the capacity of the 
blood vessels. Using 1/13 of the body weight as a basis 
for calculating the capacity of the blood vessels you can 
estimate the amount of fluid for injection at 75% of the 
capacity of the blood vessels or in case of a body weighing 
130 lbs., 7y 2 lbs. or pints of fluid. 

This is figured in this way in practice: — if the body 
weighs approximately 130 lbs., 1/13 of the weight would 
represent the capacity of the blood vessels, and 75% of 



EMBALMING FLUIDS 221 

that would be the amount of fluid that should be injected, 
which in this case is T 1 /^ pints or pounds. 

The amount of fluid to be injected into the cavities 
depends on the condition of the organs. In some bodies 
it may not be necessary to inject the cavities at all while 
in others an amount equal to the amount of fluid injected 
in the arteries would be necessary. It will be wise, how- 
ever, to inject at least x /2 gallon of fluid into the cavities, 
should any cavity injection be necessary. In cases of 
children this quantity may be altered to suit the size of 
the body. 

When drainage is to be made from the veins, a certain 
percentage of the fluid will find its way into the blood 
bottle. This makes it advisable to add to your injection, 
so that enough fluid be left in the body to maintain a 
pressure and to insure uniform, preservation. 

It is not possible for one to set definite figures as to 
the amount of fluid for the injection, as each case pre- 
sents peculiarities which must be met. Any form of in- 
jection, however, based on the filling of the circulation 
and the creation of a fluid pressure within the body 
would be satisfactory. 

Disinfection by Embalming Processes. — In addition to 
the arterial injection, the cavities which contain the vis- 
cera can be treated by a hollow needle injection. This 
provides for the disinfection of any infected organ or 
part of an organ by external contact with the fluid, and 
in some cases, such as the stomach or intestines, by the 
injection of fluid into the cavities of the various organs. 
The use of the fluid with the hollow needle is a valuable 
addition to arterial injection, 



222 EMBALMING FLUIDS 

In the absence of carbolic acid solutions or bichloride 
of mercury, the body dead of a communicable disease can 
be washed and disinfected externally by the use of 50% 
diluted fluid. 

Fluid Formulae. — We believe that regularly consti- 
tuted laboratories, as against the embalmer, are better 
able to compound fluids with greater accuracy and more 
uniform strength of chemicals. Under these circum- 
stances we recommend the use of any generally sold fluid, 
subject to the recommendations described in the fore part 
of this chapter. 

Should you need fluid at any time for emergency use, 
several formulas are appended, together with directions 
for compounding them. 

The Hygienic Laboratory Formula, according to 
Past Assistant Surgeon Edward Francis, U. S. Public 
Health and Marine Hospital Service: 

Rx. Solution of Formaldehyde IT. S. P 1 quart. 

Sodium borate U. S. P 12 ounces. 

Phenolphthalein (8% alcoholic solution) . . 1 ounce. 
Water, a sufficient quantity to make 7 quarts. 

Directions for making (by Dr. Francis). — Dissolve 
the borax in boiling water, using about 2 quarts of water 
for this purpose, and then dilute the resulting solution 
with about 2 quarts of cold water. Then add the required 
amount of solution of formaldehyde U. S. P., and the 
phenolphthalein solution. Dilute to the required volume 
(7 quarts) by adding water, and mix well. Keep in stop- 
pered containers. 



EMBALMING FLUIDS 223 

A Standard Formula : 

Rx. Solution of formaldehyde U. S. P., 1 quart. 
Sodium biborate U. S. P., 12 ounces. 

Water in sufficient quantity to make 8 quarts. 

Directions for making : Refer to directions given for 
the Hygienic Laboratory formula. 

The foregoing formulae are simple in character, yet 
sufficient in action to give all of the effects needed for 
any case, provided the fluids are used in accordance with 
the recommendations given in the fore part of this chap- 
ter. Formaldehyde is present in each to a percentage 
of 5% absolute formaldehyde in the standard formula 
and 5.66% in the Hygienic Laboratory formula. 

Mineral Poisons in Embalming Fluids. — Mineral poi- 
sons are prohibited in the manufacture of embalming 
fluids for distribution through many states. This legis- 
lation is due to the inability to determine the correct 
medico-legal aspect of a murder or suicide case that has 
been prepared with a fluid containing either mercury, 
arsenic or zinc. 

It is only timely that the embalmer should know the 
ways of determining the presence of these chemicals ; 
therefore a complete procedure for analysis of a fluid 
is incorporated in this chapter. 

We have also included tests for carbolic acid, creosote 
and formaldehyde, for no other reason than to enable 
you to study the fluid question intelligently. 

Carbolic acid and creosote solutions in use as embalm- 
ing fluids will have a tendency to darken the skin should 
they be used in excessive strengths. Knowing that a 



224 EMBALMING FLUIDS 

given fluid contains either of these chemicals, you can 
use the fluid cautiously and avoid these complications. 

General Instructions for Getting Ready for the Work 
of Analyzing your Fluid. — You will need a few test tubes 
and these can be obtained from your druggist at a very 
small cost. These are made of glass, and should be pre- 
ferably about 6 inches in length. I believe it would be 
advisable to call your attention to the fact that these 
tubes, being made of glass, should be handled very care- 
fully, so that the breakage is kept down to the minimum. 

We use a great many of these tubes in the chemical 
laboratory for the use of the students in testing out fluids 
and in analytical work, and as a rule find that the break- 
age will not amount to more than two or three tubes a 
year. This would not be the case if we did not caution 
the student about the matter. You can learn to handle 
these tubes with care and to lay them down when finished 
with them so that you will not break them. 

The only paraphernalia necessary will be some form 
of providing heat, so that the liquid in the test tube may 
be heated. This heating of the mixed solution in the test 
tube results in quicker reaction and more perfect results 
in every case. 

The usual method of heating the lower end of the 
test tube is to hold it over the flame of a bunsen burner 
(which can be obtained from any gasfitter), or an alcohol 
flame, or any other flame that may be handy. 

In holding the test tube containing the solution over 
the flame always remember to turn the tube all the time, 
and to move it back and forth through the flame. The 
object of turning the tube is to obtain as much as possible 



EMBALMING FLUIDS 225 

an even distribution of the heat, so that the danger of 
breaking the tube by expansion is removed entirely. The 
upper end of the tube will never get hot under this method 
and you will always have complete control over the tube 
without danger of burning your hands in any way. 

When you have decided the question as to what par- 
ticular chemical you are to test for, place a few drops 
of the fluid in the test tube and add a few drops of water, 
and then you are ready for the reagents. Now, the re- 
agents are solutions of chemicals having the functions of 
throwing different chemicals out of solution, or, in other 
words, of precipitating the solid elements and of disclos- 
ing the presence of different chemicals through precipita- 
tion, producing colors, etc. 

In the minute instructions for the discovery of each 
chemical, the proper reagents will be found for each, 
and now we will go on to the technique of the work after 
the preparation of the liquid for the reagents. 

Place a few drops of the proper reagents in the test 
tube along with the fluid and the water, and then slowly 
begin to bring the lower end of the tube into contact with 
the heat of the bunsen burner or other flame. Revolve 
the tube so that the heat is spread over as much of the 
surface as possible, and then watch for the reaction. You 
can see from this that reagents cause reactions that re- 
sult in the throwing of some element out of solution, and 
that element is always the chemical sought for. 

Now, to identify the chemical, you have only to refer 
to the result of the experiment as set forth in the minute 
instructions for each chemical, and if the precipitation 
is as it should be according to the instructions, or if the 



226 



EMBALMING FLUIDS 



proper color has been produced according to the instruc- 
tions, the experiment has been successful and you have 
found the chemical you are looking for. 

Now, if you have reason to believe that the chemical 
you are looking for may be present, yet your first experi- 
ment has failed to disclose its presence, then I would 
suggest that you make the experiment over again, omit- 
ting the water with the fluid and test the fluid straight 
and without water. This will naturally give you a 
stronger reaction and one which can more readily be 
seen. 

After you have tried the test twice, using the recom- 
mendations set forth here, and fail to get a reaction, then 
you can rest assured that the chemical you are looking for 
does not appear as a part of the fluid. 

Now, as soon as you have completed your test for any 
one of these elements, and have disclosed that this or that 
chemical is or is not present, then you can go on to the 
next in the list, and so forth, until the entire list of chem- 
icals prohibited by your state law have been tested for. 

If you will take the trouble to clean the test tube after 
using it, you can keep it until the next lot of fluid comes 
along and can test the next lot with the same test tubes 
and so on until by accident the tube is broken. 

Chemical Tests. — 1. Test for Mercury, Arsenic or 
Zinc, For determining whether a given fluid contains 
mercury, zinc or arsenic, or all of these. 

Get a small quantity of ten per cent, solution of sodium 
bicarbonate from your druggist. This solution is your 
reagent for determing whether all of these poisons are 



EMBALMING FLUIDS 227 

present, or whether any of them are represented in the 
formula of the fluid. 

Operation — 

(a) Place a few drops of your embalming fluid in the 
test tube then add an equal amount of ordinary water. 
Then add a few drops of the reagent (the 10 per cent, 
solution of sodium bicarbonate). 

(b) Heat the lower end of the test tube over the flame 
as provided in the general instructions. 

(c) A deposit of whitish substance in the bottom of 
the test tube indicates that all of these chemicals or any 
one of them is present. 

(d) If you fail to notice this precipitation and fail to 
see a deposit of a whitish substance in the bottom of the 
test tube, try the test over again, using fresh fluid and 
leaving out the water this time. If, after doing this, you 
find no deposit of a whitish substance, you will know that 
arsenic, mercury and zinc are not present. 

2. A. Test for Arsenic alone.— Get a small quantity 
)f 10 per cent, solution of copper sulphate and a like quan- 
tity of ammonia from your druggist. These solutions are 
your reagents for determining whether arsenic alone is 
present. 

Operation — 

(a) Place a few drops of your fluid in the test tube ; 
then add a few drops of water; then add a few drops of 
the solution of copper sulphate ; then a few drops of am- 
monia, and heat the lower end of the test tube over the 
flame, as provided in the general instructions. 

(b) A deposit or precipitation of an olive green sub- 



228 EMBALMING FLUIDS 

stance in the bottom of the test tube indicates that arsenic 
is present. 

(c) If you fail to find this olive green precipitation the 
first time, test it over again, using fresh fluid, and leave 
the water out this time. If, after doing this, you find no 
olive green precipitation, you will know that arsenic is 
not present. 

B. Test for Arsenic alone. — (Either this test or the 
preceding one can be used). 

Get a small quantity of 10 per cent, solution of silver 
nitrate, also some ammonia, from your druggist. These 
solutions are your reagents for determining whether ar- 
senic is present or not. 

Operation — 

(a) Place a few drops of your fluid in the test tube; 
then add a few drops of water; then add a few drops of 
ammonia ; then add a few drops of the silver nitrate test 
solution. 

(b) Heat the lower end of the test tube over the flame 
as provided in the general instructions. 

(c) A deposit or precipitation of an orange colored 
substance indicates that arsenic is present. 

(d) If you fail to find this orange colored substance 
the first time, test it over again, using fresh fluid and 
leave the water out this time. If, after doing this, you 
find no orange colored precipitation, you will know that 
arsenic is not present. 

3. Test for the Salts of Zinc. — (This test will operate 
for both chloride of zinc and sulphate of zinc). 

In making the test for arsenic, using the 10 per cent. 



EMBALMING FLUIDS 229 

solution of silver nitrate and the ammonia as reagents 
to give you the orange colored precipitation, and, having 
discovered by obtaining this orange color that arsenic 
was present, you have the orange colored substance left 
in the test tube. In other words, take the result of the 
silver nitrate and ammonia test and use it to find whether 
zinc is present or not. 

Operation — 

(a) Take this orange colored precipitation and the 
liquid it is contained in, and add additional ammonia until 
the liquid becomes clear again. Use the heat to assist in 
the re-dissolving. 

(b) When the solution has become clear, add a few 
drops of 10 per cent, solution of alum (which you can 
get from your druggist). 

(c) Apply the heat as directed in the general instruc- 
tions, and if there is any zinc in the solution a white pre- 
cipitate or deposit will appear in the test tube. 

(d) If the white precipitate does not appear, test it 
over again, using the result of the arsenic test again, as 
provided in section (a) of this operation, and if the white 
precipitate does not appear at this time you know that 
zinc has not been used as a part of the fluid. 

4. Test for Mercury alone. — Get a small quantity of 
10 per cent, solution of potassium iodide from your drug- 
gist. This will act as your reagent to determine whether 
mercury is present or not. 

Operation — 

(a) Take a few drops of your fluid and add a few 



230 EMBALMING FLUIDS 

drops of water and add a few drops of the potassium 
iodide solution. 

(b) Heat the lower end of the test tube over the flame 
as provided in the general instructions. 

(c) A yellow or red or yellow turning to red precipi- 
tate or deposit will indicate that mercury is present. 

(d) If this test fails to show the yellow or red or the 
yellow turning to orange precipitate, test it over again, 
using fresh fluid and fresh potassium iodide solution, 
leaving the water out this time. If you fail to get the 
colors as above stated this time, you will know that there 
is no mercury in the solution. 

5. Test for Chloral Hydrate. — Get a small quantity 
of 10 per cent, solution of caustic soda from your drug- 
gist. This will act as a reagent for the detection of 
chloral hydrate in your fluid. 

Operation — 

(a) Take a few drops of your fluid and place it in the 
test tube with a few drops of the caustic soda test so- 
lution. 

(b) Apply heat to the bottom of the test tube as pro- 
vided in the general directions. 

(c) The formation of the odor of chloroform indicates . 
the presence of chloral hydrate. 

(d) If you do not get the odor of chloroform, test 
it over again using fresh fluid and fresh caustic soda 
solution leaving the water out this time If you fail to 
get the odor of chloroform this time, you will know that 
there is no chloral hydrate in the solution. 

6. Test for Carbolic acid. (Phenol). — Get a small 



EMBALMING FLUIDS 231 

quantity of a ten per cent, solution of ferric chloride 
from your druggist. This will be your reagent for show- 
ing the presence of the carbolic acid. 

Operation — 

(a) Take a few drops of your embalming fluid and 
place in the test tube along with a few drops of the 
ferric chloride test solution. 

(b) Apply heat to the test tube as provided in the 
general instructions. 

(c) The presence of carbolic acid will be indicated 
by a black or blue color or precipitation. 

(d) To further prove the presence of carbolic acid 
you will then add a couple of crystals of oxalic acid to 
the solution and in the presence of carbolic acid the 
black or blue color will turn to a dirty yellow color. 

(e) If this test does not result in the discovery of the 
carbolic acid, test it again, using fresh fluid and fresh 
ferric chloride solution and leave out the water. If 
this additional test fails to disclose the presence of the 
carbolic acid, you will then know that it is not present. 

7. Test for Creosote (a mixture of guaiacol, cresol 
and other phenols obtained during the distillation of 
wood tar). — In making the test for carbolic acid you will 
have obtained some of the ferric chloride test solution 
from your druggist. This will act as your re-agent for 
the detection of creosote in the fluid. 

Operation — 
(a) Place a few drops of your fluid and a few drops 
of water in the test tube and add to this a drop of the 
ferric chloride test solution. 



232 EMBALMING FLUIDS 

(b) Apply heat to the lower end of the test tube as 
provided in the general instructions. 

(c) The presence of creosote will be indicated by the 
formation of a greenish-brown color, ending with a 
brownish precipitation. 

(d) If this test fails to show the presence of the creo- 
sote, make the test over again, using fresh fluid and fresh 
ferric chloride test solution and leaving the water out. 
If this test fails to result in the brownish precipitation, 
you will know that creosote has not been used in the fluid. 

8. A. Test, for Formaldehyde. — In making the test 
for chloral hydrate you will have secured from your drug- 
gist a quantity of 10 per cent, solution of caustic soda. 
Now, as an addition to this, it will be necessary to get a 
small quantity of a 10 per cent, solution of resorcin test 
solution. 

Operation — 

(a) Place a few drops of the fluid along with a few 
drops of water and a few drops of caustic soda and a few 
drops of the resorcin solution in a test tube. 

(b) Apply heat as directed in the general instructions. 
■(c) The presence of formaldehyde will be indicated by 

a reddish color of the solution. 

(d) If this test fails to show the presence of formal- 
dehyde, test it over again, using fresh liquid and caustic 
soda and resorcin solution and leaving water out. If 
this test fails to get the reddish color for you, you will 
know that there is no formaldehyde in the fluid. 

B. Another test for formaldehyde. 

In making this test you will use the silver nitrate so- 



EMBALMING FLUIDS 233 

lution and the ammonia solution which you had provided 
for other tests previous to this one. 

Operation — 

(a) Place a few drops of ammonia and silver nitrate 
solution in the test tube. 

(b) Apply heat as directed in the general instructions. 

(c) Add a few drops of your fluid and in the presence 
of formaldehyde you will see a mirror form on the inside 
of the bottom of the test tube. 

(d) If this test fails to result in a mirror on the bottom 
of your test tube, you will then take fresh ammonia and 
fresh silver nitrate solution and fresh fluid, operating as 
described in sections a-b-c, of this operation. If the mirror 
then fails to form, you will know that there is no formal- 
dehyde in your fluid. 



CHAPTER XXIV. 

ROOM DISINFECTION. 

Room Disinfection. — There is as yet no single proced- 
ure by which every article in an ordinary furnished room, 
which has become infected, can be simultaneously and 
certainly disinfected. For rendering rooms that have been 
occupied by persons suffering from contagious diseases, 
free from danger, the most trustworthy plan consists in 
a combination of the best features of several methods that 
have been from time to time proposed. 

Realizing that disinfection should be carried out from 
the very beginning of a man's illness with a contagious or 
highly infectious disease, it is thought best to devote a 
few paragraphs to the sick room and its disinfection, as 
taken from the Idaho laws relating to the duties of the 
boards of health. 

The Sick Room and Its Disinfection. — "The room 
should be located by preference in the upper part of the 
house, and as much isolated from the other parts of the 
house as possible, and it should contain as much sunlight 
and fresh air as possible ; drafts to be avoided. It should 
contain nothing except what is absolutely necessary for 
the comfort of the patient and the convenience of the at- 
tendants. Carpets and hangings and all bric-a-brac and 
unnecessary articles should be avoided or removed, and 
the room should be provided with a small gas stove, and 
234 



ROOM DISINFECTION 235 

a wash boiler of about four gallons capacity, or with a 
steam sterilizer, and all small infected articles, such as 
napkins, towels, handkerchiefs, etc., should be immersed 
in boiling water or soda solution (see page 138), or steam, 
when they become soiled or before being laundered. The 
patient should be provided with his own eating utensils, 
which should be boiled in soda solution after he has used 
them. All refuse of his meals should be burned or thrown 
into a covered receptacle containing milk of lime (see 
page 182), or a one per cent, chloride of lime solution (see 
page 183), which should be renewed each day. All furni- 
ture, the floors, door knobs, and all surfaces, such as sills, 
mantel pieces, etc., should be at least once in two days 
wiped with cloths moistened in a three per cent, solution 
of carbolic acid or a one per cent, solution of chloride of 
lime, or one part of formalin to twenty parts of water. 
A separate clinical thermometer, tongue depressor, or 
what other instruments may be necessary, should be pro- 
vided, and when not in use these articles should be kept 
in a one to three per cent, solution of carbolic acid or a 
one per cent, solution of chloride of lime. After having 
been cleansed in such solution they should be, before 
using, rinsed off with warm water. Great care should be 
taken of all bed linen, and portions of the body of the 
patient that may be soiled by evacuations, secretions or 
excretions. Portions of the body that may become soiled 
should be cleansed by a three per cent, carbolic acid so- 
lution, or by a one per cent, chloride of lime solution, and 
all bed linen or garments of the patient's that may be- 
come soiled should be removed with as little agitation as 
possible, and immersed in the following solution: 



236 ROOM DISINFECTION 

Carbolic acid 3 parts. 

Common soft soap 2 parts. 

Cold water 100 parts. 

This solution should be contained in a covered vessel 
that should be brought to the side of the bed when used. 
By immersing soiled clothing in this solution not only all 
non-spore bearing bacteria are destroyed, but in the cold 
state this solution dissolves all blood and fecal stains 
which would be rendered indelible if the soiled articles 
were exposed at once to steam or boiling water. They 
should be permitted to soak in this solution for about two 
hours, when they may be rinsed out with clean water and 
subjected to the ordinary process of laundry. 

The attendant should be protected by a cotton slip or 
coat that reaches from the neck to_ the floor, and this 
should always be worn when on duty. At the end of the 
day this garment should be immersed in either of the so- 
lutions named, after which it may be boiled or steamed 
and laundered. The attendant should also be provided 
with carpet overshoes, which should be disinfected often, 
preferably by steam, or by exposure to formaldehyde gas, 
as has been described. (See page 151) . All other infected 
clothing should be packed in tightly closing canvas bags, 
and conveyed to the rePT^ar disinfecting station, if one 
exists, to be disinfected by steam. Where such stations 
are not accessible, one may disinfect with the vapors of 
formaldehyde (see page 155). "Whenever the attendant 
leaves the room or ward both the slip and the overshoes 
should be left in the room at a point close to the door of 
exit where they can be easily reached when she or he re- 



ROOM DISINFECTION 



237 



turns. The attendant should bathe frequently. The hands, 
face, beard, and hair should be frequently rinsed in a 
one to five thousand solution bichloride of mercury, or a 
one per cent, solution of carbolic acid, or a one per cent. 




Fig. 13. — A disiniecting suit. 

solution of chloride of lime. The most desirable solution 
for sponging the entire body both of the patient and the 
attendant is one consisting of one part of Labarraque's so- 
lution to five or seven parts of water. 



238 ROOM DISINFECTION 

Room Fumigation. — The effectiveness of a fumigation 
depends upon the following: 

(1) Tightness of the room. 

(2) Length of closure. 

(3) Quality of the agent. 

(4) Temperature. 

(5) Distribution of the articles. 

(6) Moisture. 

(7) The rapidity of the generation. 

(1) The tightness of the room is one of the essential 
points in the complete fumigation of a room that is so 
often neglected. No matter how strong, efficient and 
trustworthy the gas employed may be, if the room is iot 
absolutely tight, the gas will escape, and produce only an 
antiseptic effect. 

After closing the doors and windows, (excepting the 
place of exit), seal all the cracks and crevices with 
gummed paper, or calk them with towels, waste, or the 
like. Be careful to close the hot air register and to prop- 
erly close all ventilators, fireplaces, and other openings. 

This may be done while the body is being prepared or 
after it has been prepared, and the body may remain in 
the room during the disinfection. 

"When everything is in readiness, touch off the disin- 
fectant, make your exit and seal the door on the outside. 

(2) The length of closure depends upon the agent one 
is using, but it will be safe, no matter what agent is used, 
to keep the room closed from 8 to 12 hours, when the 
room is to be opened, aired and well ventilated. 

(3) The quality of the agent will depend upon the 
following: 



ROOM DISINFECTION 



239 



(a) Controllability. 

(b) Cheapness. 

(c) Penetrability. 




Fig. 14.— Method showing how to seal doors with paper stripo (Rosenau). 

(d) Effectiveness. 

(e) Effect on fabrics. 

(a) By controllability is meant the using of the agent 



240 ROOM DISINFECTION 

which when used for fumigation purposes in a closed room 
will do just what we want it to do. Some of the agents 
which are recommended, require the use of fire for their 
generation, which is always dangerous, others are more 
or less of an inflammable and explosive nature and should 
one not knowing the nature of the agent in this regard, 
light a match or have in their mouth a lighted cigar, great 
damage would occur, even to the loss of life. For this 
reason when sulphur is the agent to be used, it should be 
placed in a tub or other vessel that has rather high sides, 
and the bottom of the vessel should contain at least one 
inch of water. The generator used in the key hole method 
is not always controllable, for in the generation of the 
gas, paraform may be formed which will clog up the noz- 
zle, causing enough back pressure on the generator to 
cause it to explode. Hydrocyanic acid gas is very inflam- 
mable and explosive and for this reason is not easily con- 
trolled. 

(b) By cheapness is meant that we should buy the 
cheapest disinfectant we can which will have all the qual- 
ities necessary to make it a good disinfecting agent. There 
are many costly disinfecting agents, but we do not get 
enough remuneration to warrant their use, and after all, 
it would not be necessary to use the costlier agents for 
there are cheaper ones on the market which when consid- 
ering all the points under the quality of the agent are even 
better. 

(c) By penetrability is meant that the agent used must 
have the power of passing into the material to be disin- 
fected to such a depth that even the most hidden germs 
will be killed by its action. Some agents are very good 



ROOM DISINFECTION 241 

surface disinfectants, but they lack the power of pene- 
tration which would render them valueless for the more 
complete disinfections. 

(d) By effectiveness is meant that the agent we are 
using should do the work which we want it to do. If 
there are germs to be destroyed, or if there be insects to 
; be killed, we must know that the agent we are using will 
be effective to that extent. Formaldehyde gas is one of 
the most efficient germicides, yet it should not be used as 
an insecticide, for it will not be effective as such. Sul- 
phur dioxide is only a poor insecticide, and for that 
agent to be of value it must be used in connection with 
water and then the active principles become the sulphur- 
ous acid gas. 

Then again our agent may be one that is very effective, 
but because we have neglected some of the other points, 
such as the tightness of the room, the length of closure, 
the temperature, the distribution of the articles, or the 
moisture, it will be rendered ineffective. 

(e) Lastly, the effect on fabrics is a very important 
point. If we have a delicate carpet, lace curtains and 
draperies with delicate shades of colors, we do not want 
these colors destroyed. 

If we have assured the owner of the property that 
there would be no damage in this regard and then should 
the damage occur because of our lack of knowledge of 
what the agent would do, the loss would be the disinfec- 
tor's and he would probably have to stand it. For this 
reason the disinfector should know the bleaching prop- 
erties of any agent he may use, especially that of sulphur 
and chlorine. 



242 ROOM DISINFECTION 

So, then, in summing up the quality of the agent, we 
find that formaldehyde is one of the best, if not the best, 
all round disinfectant that can be obtained, when consid- 
ering the above five points. 

(4) The temperature of the room should always be 
considered when one is about to disinfect a room. Thor- 
ough disinfection can not be obtained at a temperature 
less than seventy-five degrees. If the room does not hap- 
pen to be of this temperature it would be advisable to 
place a coal oil stove, a gasoline stove with an oven, or 
some other means, so as to raise the temperature up to 
the requirement. 

Temperature is an important factor in disinfecting 
with formaldehyde. The gas condenses at 20 degrees C. 
to the solid form, paraform. Disinfection with this gas 
should never be attempted if the temperature is under 10 
degrees C. In cold weather the room to be disinfected 
should be heated by artificial means, otherwise some other 
disinfecting agent must be selected. The action of the 
gas seems to be about the same between the temperatures 
of 10 degrees C. and 27 degrees C, but higher degrees of 
heat materially aid the disinfecting power of the gas. 

(5) In the distribution of the articles all materials to 
be disinfected in the room, such as clothing, etc., should be 
opened out and hung loosely upon lines stretched in the 
room for the purpose, or over the backs of chairs. Books 
handled by the patient, or suspected of being infected, 
should be burned, and in fact, all materials of little or no 
intrinsic value should be treated in the same way. All 
furniture should be moved at least a half foot away from 
the wall, and all pictures taken down from the walls and 



ROOM DISINFECTION 243 

set up on edge on the floor so that the gas may have free 
access to all sides. All bureau drawers should be opened 
out and the contents carefully spread out loosely. If 
there is an adjoining closet to the room, it should not be 
overlooked, but rather should be entered and all the con- 
tents brought out into the main room so that the material 
will have more free exposure to the gas. And last of all, 
although seldom done, the carpet should be loosened from 
the floor and several old chairs placed underneath, so 
that the gas will have a free circulation. However, with 
all the preparation, it must be remembered that all the 
infected materials and those suspected of being infected, 
should be handled as carefully and as lightly as possible, 
or else the too vigorous shaking up of the dust or infec- 
tious matter may be the means of spreading the disease. 

(6) Moisture should always be present in some form, 
as it is due to moisture that the penetration is increased. 
The disinfector must then make a study of the disinfecting 
agents to determine whether the moisture is present in 
the free state in combination with the evolved gas, or if 
the moisture will have to be added separately into the 
room to get the desired result. 

Although formaldehyde gas cannot be produced in the 
dry state, yet a certain added amount of moisture is es- 
sential to obtain successful results. It is estimated that 
the atmosphere should contain 75 per cent, of saturation 
of moisture to obtain the maximum effect. It is there- 
fore advisable in dry weather to place a basin of boiling 
water in the room just before evolving the gas, although 
most of the apparatus in the market, supplies means of 
producing watery vapor. 



244 ROOM DISINFECTION 

(7) The rapidity of generation. — There are many 
methods of evolving gases. Some of the methods are slow, 
and some are fast. For the ideal disinfection the gas 
must be thrown off with great rapidity, and in great 
quantities. This will bring a great volume of gas into 
the room to be disinfected, very quickly, and in such 
great volume that every nook and crevice will receive the 
gas and thus be disinfected. For effectiveness, then, re- 
member that there must be a rapid generation of the gas. 

General Suggestions. — The practice of setting dishes or 
receptacles about in a room in which carbolic acid, chlo- 
ride of lime, or other disinfectants are placed, has no 
effect to disinfect, and this method should be abandoned. 

It should be remembered that pure air and sunlight are 
most valuable and effective disinfectants, and that nearly 
all known disease germs are quickly destroyed, when sub- 
jected to the strong rays of the sun, hence these agents 
should be utilized whenever possible, but the sun's rays 
can not be depended upon to the exclusion of all other 
methods. 

A slow generation of gas for room fumigation is not 
very efficient, and the best results will be obtained by 
using a gas that can be evolved quickly and in great quan- 
tities. 

If more than one room in a house is to be disinfected, 
each room should be done at a time, and care taken that 
infected articles are not carried into the disinfected rooms. 

Gases as a rule can not be depended upon to exert their 
disinfecting influence very deeply, therefore any article 
which there is reason to believe is deeply or badly in- 



ROOM DISINFECTION 245 

fected should be removed for other treatment, depending 
upon its character. 

The strength of all gases and the time of exposure nec- 
essary to insure disinfection have been determined by 
exact laboratory experiments, but the conditions found in 
actual practice are so variable that we must allow for a 
liberal excess to make up for inevitable wastage. 

The steps to be taken after a room has been disinfected, 
which will aid materially in the thoroughness of the dis- 
infection are briefly as follows : 

The room should be entered and all bed clothing, pil- 
lows, mattresses, and other clothing in closets, chests, 
trunks, etc., should be put in canvas bags brought for the 
purpose by the operators and sent at once to the disin- 
fecting station, where they are to be subjected to the 
action of steam. If there is no disinfectant station in the 
community, see disinfection for clothes under special dis- 
infection (page 252). The action of steam completes the 
disinfection of those articles that were only superficially 
acted upon by the gaseous vapors. 

In the meantime, the ceiling and walls are to be wiped 
down with cloths 'wrung out in a 3 per cent, carbolic so- 
lution, a 1 : 2000 corrosive sublimate solution, or a 5 per 
cent, chloride of lime solution. All furniture and all hori- 
zontal surfaces, such as window sills, cornices, etc., are 
to be similarly wiped off, after which the floors are to be 
scrubbed with hot soda solution of about 4 per cent, 
strength. 

In the case of hangings, valuable curtains, tapestries, 
carpets, etc., that might be injured by steam, it is best to 
remove them after the general fumigation and have them 



246 ROOM DISINFECTION 

thoroughly beaten or shaken on some distant lot, after 
which they should be freely exposed to the direct sun- 
light. 

When the room has been disinfected and cleaned by 
the processes outlined above, it should be thoroughly aired 
for a few days before it is again to be occupied. 

Charges. — In the larger cities, disinfection is in the 
hands of the health boards and the expense is often borne 
by the city. There is no fixed charge for such work, but 
where formaldehyde disinfection is done, the usual price 
for a house is from $1.50 to $2.00 per 1000 cubic feet. It 
depends upon the manner in which the work is done. For 
a single room of the average size, $3.00 is a reasonable 
price, and for two rooms $5.00. In smallpox disinfection, 
it is advisable to have an assistant who is immune, (one 
who has had smallpox) do the inside work. In many cases 
it is required that all paper be removed, especially in a 
room where the patient has been sick. This is done by 
wetting down the paper with the regular corrosive solu- 
tion, and then scraping it off when soaked through. From 
a business standpoint it is suggested that in doing disin- 
fecting work in smallpox cases, the least said about it the 
better, 



CHAPTER XXV. 

ARTICLES REQUIRING SPECIAL ATTENTION. 

Air.— It is quite impossible to disinfect the air of a 
room during its occupancy by a patient. Any of the 
known volatile substances in sufficient concentration to 
kill the microorganisms would make life unbearable. It 
is therefore absurd to place such substances as carbolic 
acid, chlorinated lime, or formalin in an open pan in the 
sick room or the water closet, with the idea that they are 
serving a useful purpose in disinfecting the atmosphere 
or in preventing the spread of infection. 

The infection of few, if any, of the communicable dis- 
eases is given off in the exhaled breath. The exhaled 
breath is always sterile, no matter how many microbes 
may be contained in the inhaled air. That is, the process 
of respiration acts as a bacterial filter for the atmosphere. 
When the air becomes infected it is usually in an indirect 
way. From smallpox and the exanthemata the infection 
is given off into the air from the patient mainly in fine 
particles of epidermis that float about the compartment 
with the dust. From tuberculosis and diphtheria the in- 
fection may float into the air from the dried sputum. 

The atmosphere surrounding the patient may also be- 
come contaminated with the germs of tuberculosis, diph- 
theria, the pneumonic form of plague, and other diseases 
in which the infection is discharged from the body in the 

247 



£48 ARTICLES REQUIRING SPECIAL ATTENTION 

expectoration, by coughing, sneezing, speaking, etc. In 
these explosive expiratory movements, a fine spray is 
thrown several feet from the mouth, and may be carried 
with the currents of the air to all portions of the room. 

The infection of some diseases is carried in the air, in 
the bodies of mosquitoes, or on the bodies of flies, instead, 
as was formerly supposed, as a miasm or poison directly 
vitiating the atmosphere. Malaria, which means bad air, 
is the type of these so-called " miasmatic diseases." Prom 
this we may infer that fly-screens and mosquito netting 
are more important in many sick rooms than germicidal 
agents, as far as the dissemination of such infection? 
through the air is concerned. 

In the cases where the infection is liable to contami- 
nate the surrounding air, a thorough ventilation of the 
sick room should be maintained. The infection disposed 
of in this way is generally lost by dilution, or killed by 
the sun. There is nothing equal to the open fire place for 
the ventilation and purification of the air of the sick room, 
for by this method the infection is not only carried away, 
but is destroyed by the heat of the fire in exit. 

Proper precautions must be taken at the bedside to 
prevent the infection leaving the body in a live and vir- 
ulent form. These precautions differ for each class of in- 
fection and will be described under each disease discussed. 

The hanging of sheets wet with bichloride of mercury 
or some disinfecting solution at the doorway serves a use- 
ful purpose in arresting some of the infection that may be 
floating in the air, and thus limiting its dispersion. It 
must, however, be remembered that sheets, while serving 
a useful purpose, are not an absolute guarantee, for they 



ARTICLES REQUIRING SPECIAL ATTENTION 249 

dry out very quickly and it is difficult to make the sheet 
close the openings so that there will be no air currents 
around the edges, especially if the doorway is used for 
persons passing in and out. 

When a room has been badly infected and the air of 
the room is suspected, it should always be given a pre- 
liminary fumigation with one of the gases, which will 
diminish the probability of the infection spreading 
through the air, and will protect the operators who have 
to take up the 'carpets or prepare the bedding and the 
other contents of the room for steaming or other processes. 

Bandages, Gauze, etc. — These may be sterilized by 
boiling, steaming or dry heat, in any of the apparatus 
described under these processes. Any of these articles 
that have become soiled by usage should be burned. 

Bed Linen, Body Linen, etc. — Articles of this charac- 
ter should always be disinfected after contact with any 
of the communicable diseases, for they are very apt to be 
infected. This may readily be done by boiling or steam- 
ing, or by immersion in one of the ordinary germicidal 
solutions. Care must be taken in boiling or steaming 
woolen underwear because of their liability to shrink. 
Special care is necessary in washing and disinfecting 
towels, sheets, underwear and the like that are soiled with 
discharges, such as pus, blood, or excreta. If such articles 
are heated or boiled without special precautions being 
first taken, they will become indelibly stained by the co- 
agulation of the albuminous matter which becomes fixed 
in the fiber. A method to prepare articles of this kind 
containing stains should be to soak them in a 5 per cent. 



250 ARTICLES REQUIRING SPECIAL ATTENTION 

solution of carbolic acid for two hours, and then remove 
and wash in the ordinary way. 

Beds. — Wooden and iron beds may be effectively disin- 
fected by a mechanical cleansing with a hot disinfecting 
solution, such as bichloride of mercury, using a 1 :1000 
solution, or carbolic acid solution, using a 5 per cent, so- 
lution. Care should be taken so as not to overlook any 
of the cracks or crevices, especially in wooden beds, which 
should be taken apart. 

Bedding. — Mattresses and pillows are among the most 
difficult objects to disinfect, on account of the deep pene- 
tration required. It is often important that they should 
be thoroughly disinfected throughout their mass on ac- 
count of the very intimate contact with the patient and 
the likelihood of their being deeply soiled with the in- 
fected discharges. Therefore nothing but steam should be 
trusted to render these objects safe. 

Books. — With the exception of their external surfaces, 
books cannot be disinfected in the bookcases or on the 
shelves of houses and libraries. However, if the books 
have not been handled or exposed to infection in any way 
except by their presence in the sick room, there is no rea- 
son to consider any part of the book except the exposed 
surface infected. Such books may be rendered safe by ex- 
posing them to formaldehyde gas without first disturbing 
the books in any way. 

Books which have been handled by the patient, or 
which have been otherwise exposed to infection require 
particular care in their disinfection, on account of the diffi- 



ARTICLES REQUIRING SPECIAL ATTENTION 251 

culty of penetrating with any germicidal substance be- 
tween the leaves. 

Books may be satisfactorily disinfected in a specially 
constructed box by means of formaldehyde. They must 
be arranged to stand as wide open as possible or be hung 
on wires. Under these conditions the exposure should be 
continued twelve hours in the special chamber or box, with 
high percentages of formaldehyde and temperature of 80 
degrees C, a partial vacuum having first been produced. 

When only a few books are to be treated in the ab- 
sence of a special apparatus they may be disinfected by 
dropping two or three drops of a forty per cent, formalin 
solution on every second page, taking care to distribute 
the drops well. The book is then laid in a tight box or 
drawer in which more formalin is sprinkled, and left in 
a warm place not less than twenty-four hours. 

Pamphlets and unbound volumes may be steamed with- 
out serious harm. Steam is not applicable to the disinfec- 
tion of bound books on account of the glue and the 
leather. 

Brushes. — Good brushes can be boiled or steamed with- 
out injury, and this is the best method to disinfect them. 
If boiled in a solution containing soap, soda, borax, or one 
of the alkalies, the brush may be more readily cleansed 
of the collection of oleaginous matter and epithelial 
debris that collect about the bristles. Brushes made of 
poor bristles or glued backs are injured by boiling. Such 
brushes must be mechanically cleansed in a soap or alka- 
line solution, and then soaked for an hour in corrosive 
sublimate 1 :1000, or carbolic acid 3 to 5 per cent, solu- 
tion, or a 3 to 5 per cent, formalin solution. A brush may 



252 ARTICLES REQUIRING SPECIAL ATTENTION 

be cleansed and disinfected at the same time by mechan- 
ical washing in a 1 per cent, solution of lysol or tricresol. 
The ordinary exposure to formaldehyde gas connot be 
trusted to render the brush safe. Brushes used by the 
embalmer should always be disinfected after using them 
on a corpse. 

Cadavers. — (See care of the body after death, page 
269). 

Carriages, Ambulances, Cars, etc. — These may be dis- 
infected by having built a small tight structure in which 
they are enclosed and then surrounded with formaldehyde 
gas. By using percentages of formaldehyde gas, such 
conveyances may be given satisfactory surface disinfec- 
tion in an hour. This method would be particularly ap- 
plicable where time is an important factor. 

When the vehicle has been used for the transporta- 
tion of a communicable disease, the cushions, lap robes, 
curtains, floor carpet, upholstery, and similar objects must 
be removed. for steaming, immersion in one of the germi- 
cidal fluids, or for treatment according to the method 
given for its particular class, especially if the interior of 
the vehicle has been soiled with the discharges or other 
infectious matter. 

Clothing. — Clothing may be disinfected by a great 
variety of methods. It may be boiled, steamed, soaked 
in disinfecting solutions, or exposed to dry heat or the 
action of gases. Of all the methods steam is the most re- 
liable, but it has the disadvantage of shrinking some 
woolen goods, or creasing them or setting them out of 
shape. Good clothing and fine fabrics may be steamed 



ARTICLES REQUIRING SPECIAL ATTENTION 253 

without appreciable injury if they are exposed to steam 
under pressure, so managed that condensation and undue 
wetting are avoided, and provided that the articles are 
hung or loosely laid in the steam chamber so that they do 
not come in contact with any metal parts, and finally, pro- 
vided that, as soon as the steaming is completed, the ar- 
ticles are immediately removed and stretched and hung or 
shaken in the air until they are cooled or dried. 

The combination of high percentages of formaldehyde 
gas with dry heat in a partial vacuum is a splendid method 
for the disinfection of clothing fabrics, and baggage on a 
large scale. The method is rapid, has sufficient power to 
penetrate heavy fabrics, and is not injurious. 

Clothing may be disinfected with formaldehyde gas in 
a room or inclosure by any of the methods given for the 
evolution of the gas. Proper care must be taken to so ar- 
range the clothing that the gas may have free access to 
all the surfaces, and the exposure should not be less than 
twenty-four hours to insure penetration. 

Boiling and immersion, while very efficient, are limited 
to the disinfection of the simpler and cheaper articles of 
clothing. 

Colors. — Care must be taken not to injure colors in the 
process of disinfection. Many of the cheap prints run 
when wet, and such should not be disinfected by boiling, 
immersion in the disinfecting solutions, or by steaming. 
In steam disinfection objects are sometimes soiled by being 
in contact with other objects, dyed with soluble colors, 
and this possibility must always be guarded against in 
loading the chamber. 

Sulphurous acid gas is very ruinous in this respect. It 



254 ARTICLES REQUIRING SPECIAL ATTENTION 

bleaches practically all the vegetable and aniline dyes. It 
is very apt to discolor white lead paint, (oxide of lead), 
by the formation of black lead sulphide. It does not at- 
tack white zinc paint w T hen dry. 

Formaldehyde gas has practically no effect on colors. 
It can be used to disinfect an oil painting, water color, 
or pastel. It does not effect the coloring matter of fab- 
rics, excepting occasionally the delicate lavenders. 

Chlorine is a very active bleaching agent, and acts in- 
juriously on all the pigments commonly used in the arts. 
Chlorinated lime, and Labarraque 's solution likewise effect 
colors, on account of the chlorine liberated by their de- 
composition. 

Oxygen, ozone, and hydrogen peroxide are also very 
powerful bleaching agents. 

Solutions of mercury salts, of carbolic acid and the 
cresols, or formalin, have little special action upon pig- 
ments commonly used in the arts. 

Carpets. — Carpets and rugs are very apt to become in- 
fected with almost any of the infectious diseases, and they 
are troublesome to handle properly. In cases where they 
have become soiled with the infective discharges, or where 
gross carelessness has prevailed in the sick-room, they 
should be subjected to a preliminary exposure to one of 
the gaseous disinfectants, and then carefully taken up, 
wrapped in a sheet wet with bichloride of mercury, and 
removed for steaming. Stains due to organic matter, 
such as blood, sputum, and excreta, must be removed be- 
fore the steaming, else they will become fixed. After the 
steaming they may be given a mechanical cleansing and 
hung up in the sunlight for several days. 



ARTICLES REQUIRING SPECIAL ATTENTION 255 

Carpets that have been exposed in the sick room where 
proper precautions have not been taken at the bedside to 
prevent the spreading of contagion, may be safely treated 
without taking them up. The carpet may be disinfected 
in place by wetting it with a 5 per cent, solution of form- 
alin, and keeping the room closed not less than twenty- 
four hours, or by exposing the carpet to the action of for- 
maldehyde gas in full. strength for twenty-four hours. 

Carpets that have become infected by the spilling of 
discharges, etc., should have the contaminated area im- 
mediately saturated in a strong solution of formalin. Car- 
pets in rooms that are being given a general disinfection 
with formaldehyde gas may be sprinkled with formalin 
just before the room is closed and the gas evolved. 

Cotton. — Cotton fabrics may be boiled, steamed, and 
subjected to dry heat at 150 degrees C. for an hour, ex- 
posed to formaldehyde gas or immersed in any of the 
ordinary disinfecting solutions, without appreciable in- 
jury. 

Sulphurous acid gas not only bleaches the cotton but 
rots the fiber, owing to the action of the sulphurous acid 
which is formed by the gas in the presence of moisture and 
oxygen, and is therefore inapplicable. 

Combs. — Combs may readily be rendered safe by soak- 
ing in formalin, carbolic acid or corrosive sublimate, after 
which they may be mechanically cleansed. The rubber 
and celluloid of which combs are made will not, as a rule, 
stand boiling, steaming or dry heat. 

Draperies, Hangings, Curtains. — As a rule these fur- 
nishings of the room do not come in contact with the 



256 ARTICLES REQUIRING SPECIAL ATTENTION 

patient or the discharges, and therefore may be disinfected 
by formaldehyde gas while the room itself is being treated. 

In case these articles are contaminated so that they 
need more than a surface disinfection, they should be 
steamed, in accordance with the plan laid down for the 
handling of carpets, or immersed in one of the germicidal 
solutions. 

The sick room should not contain draperies, hangings, 
or other unnecessary articles, of this character, and it is 
always advisable to remove them, as well as the carpets 
before the possibility of contamination. 

Excreta. — Lime in one of its forms is best suited for 
the disinfection of excreta in any quantity. For small 
amounts, formalin, carbolic acid, or one of its derivatives, 
as tricresol, lysol, saprol, is efficient. 

In hospitals the infective discharges are sometimes 
boiled in an appropriate vessel, with the addition of a de- 
odorizing substance, as potassium permanganate. 

Whatever chemical substance is used, some of it should 
be placed in the vessel to receive the dejecta, and more 
of it is added afterwards and the mass thoroughly mixed. 
Let the mixture stand a sufficient length of time, depend- 
ing upon the strength and nature of the disinfectant. In 
estimating the amount of disinfectant required for the 
disinfection of excreta in camps, quarantine stations, etc., 
count upon an average of 400 grams of solid excrement 
per person per day, and 1500 to 2000 c.c. of urine. 

Excreta must always be so protected that it will not 
become a breeding place for flies and other insects, which 
are prolific ways of spreading cholera, typhoid fever, and 
perhaps other diseases. 



ARTICLES REQUIRING SPECIAL ATTENTION 257 

Milk of lime is very cheap and an efficient disinfect- 
ant for excreta. As officially prescribed for this purpose 
in the U. S. Army, it is prepared by the addition of 1 part 
by weight of the freshly slaked lime to 8 parts of 
water. 

Chlorinated lime is a powerful deodorant, vigorously 
attacking the effluvia of putrefaction, and is a useful dis- 
infecting agent for excreta. A solution of good chlorin- 
ated lime in water in the strength of 1 per cent., by weight, 
has been shown to disinfect typhoid stools and cholera 
stools in ten minutes, while a 1 per cent, solution will de- 
stroy anthrax bacillus in two hours. Thoroughly mixing 
the chlorinated lime with the fecal matter to be disin- 
fected is essential. 

In the U. S. Army a 4 per cent, strength of chlorinated 
lime in solution is officially prescribed for use in the 
disinfection of the excreta of the sick. 

Formaldehyde ranks high among the list of germici- 
dal chemicals useful for the disinfection of the dejecta. 
It penetrates deeply and is not hindered in its action by 
the albuminous matter present. Enough should be added 
so as to make 5 per cent, of the mass. The vessel must be 
tightly closed at least one hour. As a deodorizer it acts 
almost immediately. 

Carbolic acid in 5 per cent, solution added to a similar 
bulk of excreta cannot be depended upon to render the 
latter sterile in one hour. It can, however, be used for 
the disinfection of infected stools, such as cholera, typhoid, 
etc., taking care to mix well and let stand at least one 
h our. 

Tricresol, lysol, and saprol are valuable agents for the 



258 ARTICLES REQUIRING SPECIAL ATTENTION 

disinfection of fecal matter in small amounts, on account 
of their energetic action, and because their efficiency is 
not impaired by the presence of albuminous matter. Suf- 
ficient quantities of these phenol derivatives must be 
added so as to be present in 2 per cent, of the entire mass 
and thoroughly incorporated. Carbolic acid and its de- 
rivatives are more expensive than lime and without any 
special advantages. 

Ferrous sulphate is very extensively used for the dis- 
infection of excreta, but its germicidal powers are too 
weak to recommend it for this purpose. It is claimed also 
to have deodorant properties, but this is doubted by some. 
In the French army ferrous sulphate is used in 10 per 
cent, solutions, and it is officially laid down that at least 
250 c.c. of such solution should be used per day for each 
person using the latrine. 

Dry earth promotes the dislocation of the excreta, 
thus preventing putrefactive changes while absorbing the 
odors. It has no inherent germicidal or antiseptic proper- 
ties, but is a useful means of disposing of dejecta in camps 
and country places when lime and chemicals are not at 
hand. A better method under these circumstances is to 
burn the dejecta. 

The corrosive sublimate is totally unfitted for the 
disinfection of excreta, because it coagulates the albumen 
with which it combines, and therefore lacks penetration. 
It does not destroy bad odors. 

Special care of the feces, urine and the sputum should 
be taken in cases of cholera, dysentery, intestinal tuber- 
culosis, diphtheria, scarlet fever, etc. 

Privy vaults should not be tolerated in thickly popu- 



ARTICLES REQUIRING SPECIAL ATTENTION 259 

lated communities, and under all circumstances they 
should be made as near water-tight as possible and so 
arranged that their contents can be frequently removed 
after having been mixed with ashes, dry earth or lime. 
The contents of the privy vault should never be permitted 
to percolate through the soil and thus contaminate the 
surrounding wells and cellars. Probably the most prac- 
tical and cheapest disinfectant for the contents of the 
privy vault is the milk of lime. A good rule 
is to add to the vault or the cesspool about two quarts 
of milk of lime daily for each individual using the vault. 
If this amount is used, not only is the odor prevented, but 
the mass is continuously disinfected. Whenever cesspools 
or vaults are used, all infected matter such as typhoid, 
cholera and dysentery stools should be thoroughly disin- 
fected before being deposited in such vaults. 

Food. — The ordinary methods of cooking are, as a rule 
sufficient to render meats and vegetables safe from the 
danger of carrying infection. The food must be well 
cooked throughout, and afterwards must be guarded 
against contamination by dust, by flies and other insects, 
by handling with infected hands, or by contact with in- 
fected dishes. 

The remnants of food or drink that have formed part 
of the patient's meal should be burned, particularly if 
the case is one of diphtheria, tuberculosis, cholera, pneu- 
monia, or any of the exanthematous diseases in which the 
food is apt to become infected by handling or by contact 
with the secretions of the mouth. This also applies to 
food left in the room at the time of death. 

In districts where cholera and typhoid fever or epi- 



260 ARTICLES REQUIRING SPECIAL ATTENTION 

demic dysentery prevail, raw foods, such as salads, celery, 
tomatoes and fruits, may be disinfected by one-half hour 
immersion in a 3% solution of tartaric acid and afterwards 
washed in boiling water. 

There is plenty of evidence now to prove that parasitic 
and infectious diseases may be spread through the con- 
sumption of uncooked foods and vegetables, even when 
pestilent diseases do not prevail in the epidemic form. 

Roots, bulbs, fruits and other articles of food may be 
given an efficient surface disinfection by immersing them 
in a 5% solution of formalin. This treatment does not 
harm the food value of these articles and is not poisonous. 

Floors. — The floors should always be given special 
attention because they are likely to be infected. The 
sputum of tuberculosis cases, of pneumonia, diphtheria, 
etc., too frequently finds lodgment on the floor. The 
plague bacillus has been found in the dust and dirt of 
the floor. 

The floor may best be disinfected by soaking, or by a 
mechanical cleansing with any one of the strong disin- 
fecting solutions such as bichloride of mercury 1 : 1000, 
carbolic acid 5 per cent., tricresol 1 per cent., etc. 

Bichloride of mercury should not be used for the dis- 
infection of the dirt floors frequently found in the poorer 
hovels of our country. Carbolic acid, or one of its deriva- 
tives, is more trustworthy for this purpose, as its action 
is not hindered by the presence of albuminous matter. 

Furniture. — Ordinary furniture, such as chairs, tables, 
desks, bureaus, cabinets, etc., made of wood, with hard 
polished surfaces, may be effectively disinfected with for- 



ARTICLES REQUIRING SPECIAL ATTENTION 261 

nialdehyde gas or sulphurous acid gas, according to any 
of the methods given for the evolution of the gases. All 
the drawers and doors should be opened, so as to expose 
all portions to the action of the gas. 

Furniture may also be disinfected by a mechanical 
cleansing with any of the disinfecting solutions, taking 
care not to overlook any surface and to get the solution 
into all cracks and crevices. 

Upholstered furniture is one of the bugbears of the 
disinfector, on account of its bulk, its value, and the 
deeper penetration sometimes required. If the upholstery 
is leather or other impervious material, it may be treated 
with one of the germicidal liquids, care being taken to 
get well into all the puckered tucks of the cushions. If 
the article is covered with a tapestry or other pervious 
fabric, the only efficient way of rendering it safe is by 
soaking the cushions through and through with a 5% 
solution of formalin and leaving the furniture in an in- 
closed space for twenty-four hours. Fortunately this 
treatment does no special injury to fine fabrics. 

Upholstered furniture that has simply stood in the 
house or room in which a case of infectious disease has 
occurred, and which has in no way come in contact with 
the patient or the infected materials, may be considered 
as being infected merely upon the surface, and therefore 
may with perfect safety be treated by gaseous disinfec- 
tion. It is always well, in using formaldehyde, which is 
practically the only gas applicable for these objects, to 
sprinkle or wipe the surfaces of the upholstery with a 
5% solution of formalin just before closing the room pre- 
paratory to liberating the gas. 



262 ARTICLES REQUIRING SPECIAL ATTENTION 

Glassware. — Glassware, porcelain, china dishes, and 
the like, may be disinfected by boiling, steaming or im- 
mersion in any one of the disinfecting solutions. 

Hands. — The hands should be thoroughly washed off 
and disinfected after contact with infected material of 
any kind. It is very difficult to disinfect the skin, espe- 
cially around the finger nails, so that a cursory immersion 
in a bichloride solution will not suffice. After contact 
with the skin of a smallpox case or one of the exanthe- 
matous diseases, or after contamination with the dis- 
charges of cholera or typhoid, the hands should be im- 
mersed in a hot bichloride of mercury solution 1 : 1,000, 
then given a very thorough cleansing with soap and water, 
using a nail brush. After this the hands should again be 
immersed in a 1 :1,000 solution of bichloride of mercury 
for three minutes. 

An antiseptic liquid soap is desirable for use in this 
way, and we would recommend the following formulas, 
which are extremely simple and can be made with little 
trouble : Rx. 

Soft soap. 1 pound. 

Hot water, 7 pints. 

Carbolic acid, 3 ounces. 

Or, 
Rx. 

Soft soap, 1 pound. 

Hot water, 7 pints. 

Lysol, 2 ounces. 

Directions for making. Dissolve the soft soap in the 
hot water and add either the carbolic acid or the lysol. 



ARTICLES REQUIRING SPECIAL ATTENTION 263 

Instruments. — The instruments used by the embalmer 
may be disinfected by many methods, but they are best 
sterilized by a careful cleansing and boiling in a 1 : 500 
solution of sodium hydroxide, which can be made by 
dissolving 28 grains of C. P. sodium hydroxide in 1 quart 
of water. 

They should be held in the boiling solution for 15 
minutes or longer. Any stains of long standing can be 
removed by rubbing in connection with the use of this 
solution. This does not rust the steel and does not dull 
the cutting edge. 

Leather, Hides, Skins, Fur, etc.— Leather, hides, skins, 
and fur, are ruined by boiling or steaming. They may be 
treated by immersion in one of the germicidal solutions. 
Leather which had not received a surface dressing is ren- 
dered hard and brittle by wetting and should therefore 
be disinfected by one of the gases. 

Formalin fixes leather by combining with its albu- 
minous constituents, rendering it brittle, and should there- 
fore not be used for this substance. 

Linen. — Flax and linen fabrics may be boiled, steamed 
or disinfected by immersion in any of the ordinary chem- 
ical solutions used for this purpose. It may also be sub- 
jected to formaldehyde gas without appreciable harm. 
Sulphurous acid gas rots linen fiber, as it does cotton, and 
bleaches dyes, and should therefore be avoided. 

Money. — Money may convey the infection of the com- 
municable diseases, especially smallpox and the exanthe- 
mata. 

Metallic money may best be treated by immersion in 



264 ARTICLES REQUIRING SPECIAL ATTENTION 

a solution of carbolic acid 3 per cent., of formalin 3 to 5 
per cent. Boiling water, steam, or dry heat is also appli- 
cable to the disinfection of specie. 

Paper money may be disinfected by sprinkling the 
notes with formalin, taking care to sprinkle the solution 
in small drops and upon the face of each bill, then placing 
in a tight box in a warm place for six hours. 

The United States Government has recently installed 
machinery to actually wash and cleanse paper money. 
It is said that the bills are renovated and come out looking 
like new money. 

Pictures and Paintings. — Formaldehyde gas does not 
injuriously affect photographs, lithographs, prints in black 
and white or colors, or pastels, and is practically the only 
method applicable for the disinfection of these articles. 

Rags. — Eags may be disinfected by any of the meth- 
ods applicable to fabrics; but as they are especially apt 
to be contaminated with the discharges and other infec- 
tious materials, they therefore require treatment with 
methods which penetrate deeply — or, better still, methods 
which sterilize, such as steam, boiling, or immersion in 
one of the strong germicidal solutions. 

"When they are absolutely valueless the best method 
is to burn them. 

Rubber. — Rubber is injured by dry heat. Pure rubber 
may be boiled or subjected to steam under pressure with- 
out injury. 

Articles made of impure rubber, such as rubber blan- 
kets, rubber tubing, and other rubber articles used by 
the embalmer, are ruined by boiling or steaming, and must 



Articles requiring special attention 265 

be disinfected by immersion in one of the germicidal 
solutions. 

Silks. — Silks seldom need disinfection, and fortunately 
so, for it is difficult to treat without injury to the texture 
or color. Formaldehyde gas does not injure the fiber and 
has no effect upon the great majority of colors; but the 
delicate lavenders of aniline origin are sometimes slightly 
modified in tint after exposure to this gas. 

While steam does injure the silk fiber appreciably, it 
ruins the fabric, so that this method of disinfection is 
totally inapplicable. 

Sputum. — The sputum, not alone of the sick, but of 
the well also, and likewise the purge from a dead body, 
is often ladened with the infection of disease, especially 
pneumonia, pulmonary tuberculosis, diphtheria, plague, 
and other affections of the air passages. 

Infection is spread by means of the sputum, especially 
when it dries and is disseminated by the air currents. 
Another fruitful method of spreading diseases, the infec- 
tion of which is found in the sputum, is by the act of 
kissing ; also by using spoons, forks, cups, etc., which have 
been in the mouth of the sick or those whose sputum is 
infected and shortly afterward used without being disin- 
fected. There is still another way in which sputum con- 
taminates the air and the surfaces of objects, viz., in 
coughing, sneezing, speaking, and other acts of an explo- 
sive expiratory character the sputum is sprayed into the 
air of the room, often to a considerable distance, even a 
couple of yards from the mouth, and the air currents will 
carry the minute droplets to all parts of a room. 



266 ARTICLES REQUIRING SPECIAL ATTENTION 

The sputum should be kept well covered until it is 
disposed of. Simply keeping water in the bedside cups 
or in the cuspidors will prevent the danger of the dissem- 
ination of infection through the agency of dried sputum, 
though an antiseptic solution is to be preferred for this 
purpose. 

The best way to disinfect sputum is by heat; a small 
quantity placed on the fire will burn up. The same meth- 
od is also applicable for handkerchiefs and other objects 
that have been used to hold sputum. 

Next to burning, boiling or steaming is the safest 
method of treating infected sputum. The boiling may 
be accomplished in any appropriate vessel, and the steam- 
ing may be done in either streaming steam or in the auto- 
clave under pressure. In hospitals and in private houses 
this method is recommended, care being taken not to heat 
the ordinary glass or glazed earthenware cuspidors too 
suddenly for fear of breaking them. 

The disinfection of sputum is difficult to accomplish 
with the chemical solutions, on account of its dense con- 
sistency and tenacious character, which hinder penetra- 
tion. Bichloride of mercury solutions are entirely inap- 
plicable to the disinfection of this material. The bichlor- 
ide of mercury coagulates the albuminous matter of the 
sputum and thereby prevents penetration, and by uniting 
with the albuminous substances it is used up and rendered 
inert so far as its disinfecting powers are concerned. 

Carbolic acid in 5% solution may be used for the disin- 
fection of sputum, but it can not be considered trust- 
worthy, because it coagulates the albuminoid matter, 
though not so energetically as bichloride of mercury. 



Articles requiring special attention 267 

Tricresol or lysol in 2% solutions are well suited for 
this purpose. 

Formalin in three to five per cent, solutions may also 
be used, using generous amounts and well incorporated, 
and remaining in contact with the infected sputum no less 
than one hour. 

Table Ware. — Great care must be exercised in disin- 
fecting knives, forks, spoons and dishes used by patients 
suffering from communicable diseases. Cholera, typhoid, 
tuberculosis, pneumonia, diphtheria, plague, and the ex- 
anthemata may be conveyed by inattention to this pre- 
caution. Table ware is most readily disinfected by scald- 
ing. 

Urine. — The urine is usually disinfected with the ex- 
creta. It should always be disinfected in the case of 
cholera, typhoid, and most of the communicable diseases, 
by adding sufficient carbolic acid to make a 5% solution, 
of bichloride of mercury to make a 1 :1,000 solution, or 
formalin sufficient to to be present in the proportion of 
3 to 5 per cent. 

Walls. — The walls and ceiling of a room are as a rule 
infected only superficially, and may be effectively disin- 
fected by one of the gaseous processes. Such surfaces 
may also be disinfected by washing down with bichloride 
or carbolic solutions, preferably hot and applied by means 
of a hose or any other method that will thoroughly wet 
the surface. The solution is always to remain until it 
dries, and is followed by a mechanical cleansing. When 
applicable it is better to scrub or mop the wall with the 
hot disinfectant solution by means of brushes, cloths, etc. 



268 ARTICLES REQUIRING SPECIAL ATTENTION 

The spraying of walls and other surfaces with a very fine 
spray of corrosive sublimate solution, or any material 
that is not volatile at the ordinary temperature, is a very 
faulty method, for the entire surface is not wetted and 
portions thus escape disinfection. In applying the so- 
lution with a hose it is always advisable to begin with 
one corner of the ceiling, and systematically wet every 
portion of the ceiling, walls and floor, from above 
downward. This method is particularly applicable to the 
holds and compartments of vessels, to freight cars, out- 
houses, cellars, waterclosets, wooden buildings and other 
rough structures. 

Disinfection of One's Own Person. — Lay aside all un- 
necessary clothing. In the absence of a disinfecting suit, 
wear duck trousers tied around the ankles, and a duck 
coat buttoned to the chin. Tie sleeves at the wrist. A 
skull cap, made by taking a handkerchief and tieing 
knots in the four corners, and a pair of rubber shoes, will 
complete the outfit. 

In handling diphtheria and scarlet fever, wrap the 
body in a sheet saturated with a solution of 1 :1,000 
corrosive sublimate. Remove body to an adjoining room 
if possible during the disinfection of the room, first having 
thoroughly disinfected and embalmed the body. 

After finishing the work, your suit may be taken off 
and disinfected by placing it in a tight satchel into which 
some 40 per cent, formaldehyde has been poured. Wash 
your entire body with a 1 : 3,000 bichloride of mercury 
solution, being careful not to touch the eyes or the mucous 
surfaces. 



ARTICLES REQUIRING SPECIAL ATTENTION 269 

Then wash in clean water, after which soap may be 
used. Do not neglect a thorough washing of the hair and 
finger nails. An alcohol wash, in addition to the above, 
is beneficial. Put on clean clothing. The shoes should 
be sponged off with bichloride. Where an old suit has 
been worn for this work it should be burned. 

Rubber gloves are always reliable in handling con- 
tagious diseases. 

"When carbolic acid is used for disinfecting the hands, 
face or other parts of the body, use 2 per cent, solution 
or 2^ ounces to a gallon of water. 

The Care of the Body After Death. — In the most dan- 
gerous communicable diseases the subject should be thor- 
oughly washed with a 2% solution of carbolic acid, or a 
4% solution of chloride of lime, or a 1:1,000 solution of 
bichloride of mercury. After these solutions have been 
allowed to dry on the subject, they should then be washed 
with soap and water. After this a thorough arterial and 
cavity embalming should follow. In all cases the rectum 
and orifices of the body should be tightly plugged with 
cotton soaked in corrosive sublimate or carbolic acid 
solutions. 

Then it is advisable that the body be at once enveloped 
in a sheet saturated with either a 5% carbolic solution or 
a 4% chloride of lime solution, or a 1 :1000 solution of 
bichloride of mercury, and placed in the casket in which 
it is to be buried. (See the State Board rules). These 
cadavers should be buried as soon as decency permits. 
The law should, and usually does, forbid a public funeral 
in these cases. 

With the less dangerous of the infectious diseases, 



270 ARTICLES REQUIRING SPECIAL ATTENTION 

such stringent measures are not observed. The body may 
be washed in any of the strong disinfectant solutions 
mentioned. The rectum should be plugged in all cases, 
especially in those of intestinal infection, and the mouth 
and nose also, especially in pulmonary and throat infec- 
tions. A thorough arterial and cavity embalming should 
follow. 

Even in the milder infectious cases it is not advisable 
to expose the remains in open caskets. 

All bodies should be buried or cremated, the results 
of the two processes of final disposal differing, as a rule, 
only in the time required for their accomplishment. 

The burial of bodies of persons dying from infectious 
diseases does not, as has been sometimes surmised, tend 
to perpetuate pathogenic germs. Rather elaborate exper- 
iments by Losener and others have shown that the longev- 
ity of non-spore-bearing bacteria under the ordinary con- 
ditions of earth burial is not great, a few weeks sufficing 
for the complete disappearance of the cholera spirillum 
and the bacillus of diphtheria, etc. 

"The hygienic arguments against earth burial, there- 
fore, do not seem to be decisive, whatever be the force 
of the aesthetic and economic objections." — Jordan. 

When a body is buried, the place selected should be 
so located as not to endanger the neighboring drinking- 
water supplies. 

The Transportation of Dead Bodies. — When the trans- 
portation of dead bodies became so general that rules and 
regulations for the government of this branch of railroad 
and express traffic became necessary, every state made 
rules to govern the traffic within its own boundary lines. 



ARTICLES REQUIRING SPECIAL ATTENTION 271 

This gave rise to a condition of misunderstanding and wor- 
riment on the part of shipping and receiving funeral di- 
rectors, which was caused by the conflicting rules in each 
state that the body might pass through. The preparation 
of the body in a manner prescribed in one state was not 
considered sufficient in another, and so the conditions 
relative to the transportation w r ere highly unsatisfactory, 

In some states the rules were formulated by legislative 
enactment, and in some the control of the laws was placed 
in the hands of the health authorities. The transporta- 
tion companies, realizing the importance of uniform laws 
to regulate this matter, communicated with the National 
Funeral Directors' Association. The result was that the 
National Funeral Directors' Association appointed a com- 
mittee of conference with a like committee of health 
authorities and general baggage agents, at Cleveland, 0., 
in June, 1897. At this meeting a set of rules and regula- 
tions were prepared, and committees appointed to submit 
them to the National Conference of Boards of Health, 
which met at Nashville, Tenn., in August of the same year. 
On account of there being no National Board of Health, 
this w^as the only body to which they could be submitted, 
and the recommendation and adoption of them would 
make it general throughout tin, United States. Eminent 
lawyers were engaged to look up the power of the Boards 
of Health in the different States, and their opinions were 
that these bodies could regulate the transportation of the 
dead, and that their rules and regulations would have the 
same effect and power of law. 

At this meeting the rules were generally discussed, 
and with some slight amendments were adopted and are 



272 ARTICLES REQUIRING SPECIAL ATTENTION 

now iii general force throughout the United States and 
Canada. Prior to this, embalming was not looked upon 
as being an important factor in the transportation of 
dead bodies. Air-tight sealing was required where the 
distance traveled took more than eighteen hours by rail, 
regardless of the time the body had been dead. The trans- 
portation of bodies dead of diphtheria, scarlet fever, etc., 
was not allowed. At the meeting above mentioned the 
health boards made certain regulations which would per- 
mit these bodies to be transported provided the persons 
preparing such bodies were fully competent. Almost all 
of the State Boards of Health have adopted these rules, 
and all railroad companies are receiving such bodies for 
shipment. 

Because of a difference in the meaning and verbiage 
of transportation rules in many instances, it will be neces- 
sary to refer you to the rules of your own state which 
appear on the back of the shipping papers used in your 
state. 

THE END. 



INDEX 



(References are to pages) 



Acquired immunity, 117 

Actinonycosis, 75 

Active acquired immunity, 117 

Age, 8 

Air, 247 

Air-slaked lime, 183 

Ambulances, 252 

American standard, 183 

Analysis of fluid, 224 

Anthrax, 63 

Antiseptic, definition of, 119 

Antiseptics, 147, 188 

Antiseptics, list of, 188 

Antitoxins, 54 

Arsenic, 199 

Arsenic test, 226, 227, 228 

Arsenite of lead, 200 

Ashes, 214 

Atmospheric pressure, 128 

Auto-infection, 53 

B. 

Bacilli, 32 

Bacteria, 26 

Bacteria, discovery of, 19 

Bacteria, chromogenic, 37 

Bacteria, aerogenic, 38 

Bacteria, in air, 23 

Bacteria, in soil, 24 

Bacteria, life history outside of 

body, 55 
Bacteria, morphology, 26 
Bacteria, oxygen supply, 35 
Bacteria, pathogenic, 39 
Bacteria, photogenic, 38 
Bacteria, products they live 

on, 34 
Bacteria, products they pro- 
duce, 35 
Bacteria, requirements, 27 
Bacteria, saprogenic, 35 
Bacteria, significance, 25 
Bacteria, thermogenic, 38 
Bacteria, toxicogenic, 39 
Bacteria, zymogenic, 35 
Bacteriology, 19 
Bacteriology, origin of, 21 
Bacteriology, sanitary, 1 



Bacteriology, scope of, 22 

Bacterium, 17 

Bad results with embalming" 

fluids, 216 
Bandages, 249 
Bedding, 250 
Bed linen, 249 
Beds, 250 

Bichloride of mercury, 176 
Bisulphide of carbon, 201 
Blood solvents, 147, 191 
Bleachers, 147, 193 
Bisulphide of lime, 206 
Body, care of after death, 269 
Body, ideal condition, 218 
Body, linen, 249 
Body, transportation of, 270 
Boiling water, 137 
Books, 250 
Brushes, 251 
Burning, 134 

C. 

Cadavers, 252 
Carbolic acid, 177 
Carbolic acid test, 230 
Carbolic sulphuric acid, 184 
Care of body after death, 269 
Carpets, 254 
Carriages, 252 
Cars, 252 
Caustic lime, 183 
Centigrade, 141 
Chamberland solution, 183 
Charcoal, 214 

Chemical causes of disease, 14 
Chemical disinfection, 143 
Chemicals, classification of, 146 
Chicken-pox, 110 
Chloral hydrate test. 230 
Chloride of lime, 183 
Chlorides "Piatt's", 213 
Chlorinated lime, 212 
Circulation, problem of. 218 
Cholera. 96 
Chlorine gas, 168 
Classification of chemicals, 146 
Clothing, 252 

273 



274 



INDEX 



(References are to pages) 



Cocci, 29 
Cold, 13 
Colors, 253 
Combs, 255 
Contagion, 48 
Copper sulphate, 212 
Cotton, 255 
Creolin, 180 
Creosote test, 231 
Cresols, 179 
Currents, electric, 129 
Curtains, 255 

D. 

Dengue, 75 

Density of population, 12 
Deodorant, definition of, 119, 211 
Deodorant, false, 120, 211 
Deodorants, 147, 211 
Deodorant, true, 120, 211 
Deodorizer, definition of, 119 
Dessication, natural. 127 
Destruction of rats, 208 
Diphtheria, 80 
Diplobacilli, 33 
Diplococci, 31 
Direct method, 155 
Discontinuous method, 140 
Disease, acute, 50 
Disease, chemical causes, 14 
Disease, chronic, 50 
Disease, classification of, 47 
Disease, contagious, 49 
Disease, definition of, 47 
Disease, discovery of what 

causes, 51 
Disease, disinfection for. 63 
Disease, endemic, 49 
Disease, epidemic, 50 
Disease, exciting causes, 14 
Disease, germ, 18 
Disease, infections, 48 
Disease, mechanical causes, 15 
Disease, non-contagious, 49, 63 
Disease, non-infectious, 47 
Disease, non-specific, 50 
Disease, pandemic, 50 
Disease, physical causes, 15 
Disease, predisposing causes, 1, 7 
Disease, prophylaxis, 113 
Disease, self-limited, 50 
Disease, slightly contagious, 80 
Disease, specific, 50 
Disease, sporadic, 50 
Disease, unlimited. 51 
Disease, vital causes, 17 
Diseases, very contagious, 104 
Disinfectant, definition of, 119 
Disinfectants, gaseous, 147, 150 
Disinfectants, liquid, 147, 172 
Disinfectants solid, 147, 185 
Disinfection, 119 



Disinfection by embalming: 

processes, 221 
Disinfection, chemical, 143 
Disinfection, definition of, 119 
Disinfection for communicable 

diseases, 63 
Disinfection for sick-room, 234 
Disinfection, liquid, 172 
Disinfection, mechanical, 129 . 
Disinfection of one's body, 268 
Disinfection, physical, 124 
Disinfection, room, 234 
Disinfection, thermal, 133 
Draperies, 255 
Dry heat,134 
Dry tissues, 219 
Dysentery, 76 

E. 

Earth, 214 

Electric currents, 129 

Electricity, natural, 127 

Electric light, 130 

Embalming fluid, 147, 215 

Embalming fluids, amount to 
inject, 220 

Embalming fluids, bad results, 
216 

Embalming fluids, formulae, 222 

Embalming fluids, mineral poi- 
sons in, 223 

Embryo, 17 

Erysipelas, 66 

Exciting causes of diseases, 14 

Excreta, 256 



Fahrenheit, 141 

False deodorant, 120, 121 

Feces, 256 

Fernback, solution, 183 

Filtration, 130 

Flame, 134 

Floors, 260 

Flowers of sulphur, 206 

Fluid, amount to in.iect. 220 

Fluid, analysis, 224 

Fluid, embalming, 147 

Fluid, formulae, 222. 

Formaldehyde gas, 151, 207 

Formaldehyde gas, methods of 
producing 154, 155, 157, 158, 160, 
161, 164, 165 

Formaldehyde test, 232 

Formalin, 172, 212 

Formalin permanganate meth- 
od, 164 

Formalin quicklime method 165 

Formulae, fluid, 222 

Fumigation charges for, 246 



INDEX 



275 



(References are to pages) 



Fumigation, definition of, 121, 

119 
Fumigation, room, 238 
Fur, 263 

G. 

Gaseous, disinfectants, 147, 150 

Gauze, 249 

Germ cell, 18 

Germ disease, 18 

Germ force, 18 

Germicide, definition of. 119 

Germ plasm, 18 

Germs, 17 

Germs, classification. 30 

Germs, how they enter the 

body, 52 
Germs, lesions produced, 54 
Germs, manner of elimination, 55 
Germs, their distribution in the 

body, 53 
Germ theory, 18 
Glanders, 68 
Glassware, 262 
Gonorrhea, 69 

H 
Hands, 262 
Hangings, 255 
Hardening compound, 147 
Heat, 13 
Heat, dry, 134 
Heating method, 160 
Heredity, 12 
Hides, 263 
How to make solutions. 174. 176. 

179 
Hunger, 13 

Hydrocyanic acid, 170, 202 
Hydrophobia, 70 
Hygiene, definition of. 1 



Ideal condition of body, 218 
Immunity, 115 
Immunity, acquired, 117 
Immunity, active acquired, 117 
Immunity, natural, 116 
Immunity, passive acquired, 118 
Incubation period, 52 
Infection, 48 
Influenza, 95 
Inocultaion, 48 
Insecticides, 147, 196 
Insecticides, use around a dead 

body, 210 
Instruments, 263 
Iron sulphate, 212 

K. 
Key-hole method, 158 



Labarraque's solution, 184, 237 

Leather, 263 

Leprosy, 94 

Light, 125 

Light, electric, 130 

Lime, 181, 186 

Lime water, 182 

Linen, 263 

Liquid chlorinated lime. 183 

Liquid disinfectants, 147, 172 

Liquid disinfection. 172 

List of antiseptics, 188 

London purple, 200 

Lysol, 181 

M. 

Magnesium sulphate, 185 

Malaria, 77 

Measles, 108 

Mechanical causes of disease. 15 

Mechanical disinfection. 129 

Medium tissues, 219 

Meningitis, 66 

Mercury test, 226, 229 

Method of producing formalde- 
hyde gas, 154, 155, 157. 158. 
160, 161, 164, 165. 

Microbe, 17 

Micrococci, 31 

Milk of lime, 182 . 

Mineral poisons in embalming: 
fluids, 223 

Moist tissues, 219 

Money, 263 

Moulds, 42 

Mumps, 109 

N. 

Natural dessication. 127 
Natural electricity, 127 
Natural immunity, 116 



Occupation, 11 

Ovum, 17 

Oxygen, 169 

Ozone, 127, 130, 131. 170 



Paintings, 264 
Paraform 151, 152 
Paraform method. 157 
Parasites, 34 
Parasites, animals. 18 
Parasites, vegetable. 19 
Paris green, 199 
Passive acquired immunity, 118 



276 



INDEX 



(References are to pages) 



Pasteurization, 92 

Petroleum, 203 

Physical cause of diseases, 15 

Physical disinfection. 124 

Pictures, 264 

Plague, 101 

Piatt's chlorides. 213 

Pneumonia, 94 

Population, density of. 12 

Potassuim permanganate, 213 

Predisposing causes to disease, 

1, 7 
Preservatives, 147 
Pressure, atmospheric, 128 
Pressure steam under. 140 
Problem of circulation, 218 
Prophylaxis in disease. 113 
Putrefaction, 21, 35, 120 . 
Pyrethrum, 204 

R. 
Race, 10 
Rags, 264 

Relapsing fever, 71 
Roentgen rays, 130 
Room disinfection. 234 
Room fumigation, 238 

S. 

Saponate, 181 

Saprol, 181 

Saprophytes, 34 

Sarcinae, 32 

Saw dust, 185 

Scarlet fever, 104 

Scheele's green, 199 

Seasons, 12 

Sex, 9 

Sheet method, 161 

Sick-room disinfection, 234 

Silks, 265 

Skins, 263 

Slacked lime, 182 

Small-pox, 105 

Solid disinfectants. 147. 185 

Solution, how to make bichlo- 
ride of mercury. 176 

Solution, now to make carbolic 
acid, 179 

Solution, how to make form- 
alin, 174 

Solutol, 181 

Special processes, 119 

Spirilla, 33 

Spirochaeta, 33 

Spore, 17, 28 



Spraying method, 161 

Staphylococci, 31 

Steam, 139 

Steam under pressure, 140 

Sterilization, 119, 133 

Sterilization, definition. 121. 133 

Streptobacilli 33 

Sulphur. 205 

Sulphurous acid gas. 165. 205 

Susceptibility, 115 

Syphilis, 71 

T. 

Tableware, 267 

Test for arsenic, 226. 227. 228 

Test for carbolic acid. 230 

Test for chloral hydrate, 230 

Test for creosote, 231 

Test for formaldehyde, 232 

Test for mercury, 226, 229 

Test for zinc, 226, 228 

Tetanus, 72 

Tetrads, 31 

Thermal disinfection. 133 

Thirst, 13 

Tissues, dry, medium moist. 219 

Toxins and antitoxins. 54 

Transportation of bodies. 270 

Trioxymethylene, 151, 152 

True deodorant, 120. 211 

Tuberculosis, 84 

Typhoid fever, 87 

Typhus fever, 111 



Urine, 267 



TJ. 



V. 



Vibrio, 33 

Vital causes of disease. 17 

Vital processes, 115 

W. 

Walls, 267 
Water, boiling, 137 
White-wash, 182 
Whooping-cough, 110 



Yeasts, 40 
Yellow fever, 78 



Z. 

Zinc chloride, 186 
Zinc test, 226, 228 



APR 10 1918 



